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Effect of Academic Detailing on Promoting Appropriate Prescribing of Antipsychotic Medication in Nursing Homes: A Cluster Randomized Clinical Trial

IMPORTANCE: Strategies to reduce the inappropriate prescription of antipsychotics have been the focus of recent attention but have shown considerable variation in their effectiveness. OBJECTIVE: To evaluate the effectiveness of academic detailing in nursing homes targeting appropriate prescribing of...

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Autores principales: Tadrous, Mina, Fung, Kinwah, Desveaux, Laura, Gomes, Tara, Taljaard, Monica, Grimshaw, Jeremy M., Bell, Chaim M., Ivers, Noah M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251442/
https://www.ncbi.nlm.nih.gov/pubmed/32453383
http://dx.doi.org/10.1001/jamanetworkopen.2020.5724
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author Tadrous, Mina
Fung, Kinwah
Desveaux, Laura
Gomes, Tara
Taljaard, Monica
Grimshaw, Jeremy M.
Bell, Chaim M.
Ivers, Noah M.
author_facet Tadrous, Mina
Fung, Kinwah
Desveaux, Laura
Gomes, Tara
Taljaard, Monica
Grimshaw, Jeremy M.
Bell, Chaim M.
Ivers, Noah M.
author_sort Tadrous, Mina
collection PubMed
description IMPORTANCE: Strategies to reduce the inappropriate prescription of antipsychotics have been the focus of recent attention but have shown considerable variation in their effectiveness. OBJECTIVE: To evaluate the effectiveness of academic detailing in nursing homes targeting appropriate prescribing of antipsychotics. DESIGN, SETTING, AND PARTICIPANTS: We conducted a pragmatic, cluster randomized clinical trial comparing the effect of academic detailing vs usual care on prescribing antipsychotics in 40 nursing homes with 5363 residents in Ontario, Canada. Data were collected from October 2015 to March 2016 and analyzed from April to August 2018. Primary analyses were conducted using intention to treat. INTERVENTION: Academic detailing delivered by health professionals (eg, nurses or pharmacists) who arranged meetings (with administrators, physicians, pharmacists, nurses, and support workers), presentations, group visits (with 2-6 clinicians), and 1-on-1 visits (traditional academic detailing visits). Academic detailers had direct and ongoing contact with the nursing homes from the time of launch. MAIN OUTCOMES AND MEASURES: The primary outcome, defined at the level of the resident, was whether continuous antipsychotics were dispensed in the past week. Secondary outcomes included prescribing of other psychotropic medications and clinical outcomes and scores. Prescribing outcomes were assessed at baseline and at 3, 6, and 12 months, and clinical outcomes and scores were assessed at baseline and 3 and 6 months. RESULTS: A total of 40 nursing homes with 5363 residents were randomized, with 18 intervention homes (45.0%; 2303 [42.9%] residents) and 22 control homes (55.0%; 3060 [57.1%] residents). Participants in the intervention and control groups had similar median (interquartile range) age (86 [79-91] years vs 85 [78-90] years) and sex (674 [29.3%] men vs 970 [31.7%] men). At 12 months, there was no statistically significant difference in the frequency of daily antipsychotic use (intervention: 569 patients [25.2%]; control: 769 [25.6%]; odds ratio, 1.06; 95% CI, 0.93-1.20; P = .49). There were no significant differences in the rates of health care utilization, but the intervention group did experience a statistically significant reduction in pain compared with the control group (mean [SD] pain score, 0.30 [0.59] vs 0.38 [0.66]; P < .001) and depression (mean [SD] Depression Rating Scale score, 2.18 [2.37] vs 2.81 [2.65]; P < .001) at 6 months. CONCLUSIONS AND RELEVANCE: The intervention did not further reduce antipsychotic prescribing in nursing homes beyond system-level secular trends occurring alongside usual care. Our findings highlight the need for a more targeted approach to quality improvement strategies, including academic detailing, that account for the timing and topic of interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02604056
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spelling pubmed-72514422020-06-05 Effect of Academic Detailing on Promoting Appropriate Prescribing of Antipsychotic Medication in Nursing Homes: A Cluster Randomized Clinical Trial Tadrous, Mina Fung, Kinwah Desveaux, Laura Gomes, Tara Taljaard, Monica Grimshaw, Jeremy M. Bell, Chaim M. Ivers, Noah M. JAMA Netw Open Original Investigation IMPORTANCE: Strategies to reduce the inappropriate prescription of antipsychotics have been the focus of recent attention but have shown considerable variation in their effectiveness. OBJECTIVE: To evaluate the effectiveness of academic detailing in nursing homes targeting appropriate prescribing of antipsychotics. DESIGN, SETTING, AND PARTICIPANTS: We conducted a pragmatic, cluster randomized clinical trial comparing the effect of academic detailing vs usual care on prescribing antipsychotics in 40 nursing homes with 5363 residents in Ontario, Canada. Data were collected from October 2015 to March 2016 and analyzed from April to August 2018. Primary analyses were conducted using intention to treat. INTERVENTION: Academic detailing delivered by health professionals (eg, nurses or pharmacists) who arranged meetings (with administrators, physicians, pharmacists, nurses, and support workers), presentations, group visits (with 2-6 clinicians), and 1-on-1 visits (traditional academic detailing visits). Academic detailers had direct and ongoing contact with the nursing homes from the time of launch. MAIN OUTCOMES AND MEASURES: The primary outcome, defined at the level of the resident, was whether continuous antipsychotics were dispensed in the past week. Secondary outcomes included prescribing of other psychotropic medications and clinical outcomes and scores. Prescribing outcomes were assessed at baseline and at 3, 6, and 12 months, and clinical outcomes and scores were assessed at baseline and 3 and 6 months. RESULTS: A total of 40 nursing homes with 5363 residents were randomized, with 18 intervention homes (45.0%; 2303 [42.9%] residents) and 22 control homes (55.0%; 3060 [57.1%] residents). Participants in the intervention and control groups had similar median (interquartile range) age (86 [79-91] years vs 85 [78-90] years) and sex (674 [29.3%] men vs 970 [31.7%] men). At 12 months, there was no statistically significant difference in the frequency of daily antipsychotic use (intervention: 569 patients [25.2%]; control: 769 [25.6%]; odds ratio, 1.06; 95% CI, 0.93-1.20; P = .49). There were no significant differences in the rates of health care utilization, but the intervention group did experience a statistically significant reduction in pain compared with the control group (mean [SD] pain score, 0.30 [0.59] vs 0.38 [0.66]; P < .001) and depression (mean [SD] Depression Rating Scale score, 2.18 [2.37] vs 2.81 [2.65]; P < .001) at 6 months. CONCLUSIONS AND RELEVANCE: The intervention did not further reduce antipsychotic prescribing in nursing homes beyond system-level secular trends occurring alongside usual care. Our findings highlight the need for a more targeted approach to quality improvement strategies, including academic detailing, that account for the timing and topic of interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02604056 American Medical Association 2020-05-26 /pmc/articles/PMC7251442/ /pubmed/32453383 http://dx.doi.org/10.1001/jamanetworkopen.2020.5724 Text en Copyright 2020 Tadrous M et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Tadrous, Mina
Fung, Kinwah
Desveaux, Laura
Gomes, Tara
Taljaard, Monica
Grimshaw, Jeremy M.
Bell, Chaim M.
Ivers, Noah M.
Effect of Academic Detailing on Promoting Appropriate Prescribing of Antipsychotic Medication in Nursing Homes: A Cluster Randomized Clinical Trial
title Effect of Academic Detailing on Promoting Appropriate Prescribing of Antipsychotic Medication in Nursing Homes: A Cluster Randomized Clinical Trial
title_full Effect of Academic Detailing on Promoting Appropriate Prescribing of Antipsychotic Medication in Nursing Homes: A Cluster Randomized Clinical Trial
title_fullStr Effect of Academic Detailing on Promoting Appropriate Prescribing of Antipsychotic Medication in Nursing Homes: A Cluster Randomized Clinical Trial
title_full_unstemmed Effect of Academic Detailing on Promoting Appropriate Prescribing of Antipsychotic Medication in Nursing Homes: A Cluster Randomized Clinical Trial
title_short Effect of Academic Detailing on Promoting Appropriate Prescribing of Antipsychotic Medication in Nursing Homes: A Cluster Randomized Clinical Trial
title_sort effect of academic detailing on promoting appropriate prescribing of antipsychotic medication in nursing homes: a cluster randomized clinical trial
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251442/
https://www.ncbi.nlm.nih.gov/pubmed/32453383
http://dx.doi.org/10.1001/jamanetworkopen.2020.5724
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