John Hirdes, Ph.D.

Quality improvement interventions can substantially reduce antipsychotic drug use in eldercare facilities, a multi-setting investigation has found.

The study’s authors provided education, training, and support to nursing home quality improvement teams in six Canadian provinces and/or territories. Support tools were designed to help staff respond to residents’ dementia-associated behaviors. The goal was to reduce antipsychotic medication use in residents who did not have a diagnosis of psychosis. Participants were also trained in improving staff collaboration, and enhancing medication review procedures.

The interventions had a “dramatic” impact on antipsychotic use independent of historical trends, simultaneous local initiatives, and individual level risk factors, according to investigators. Training and support was tied to a “substantial increase in the odds that these medications would be discontinued among residents without a diagnosis of psychosis or mental health symptoms,” they wrote. 

Notably, there was no evidence that reduction of antipsychotics contributed to worsening behavioral symptoms or to use of physical restraints at any of the study facilities.

“This improvement in performance was independent of secular trends toward reduced antipsychotic use in participating provinces,” concluded John Hirdes, Ph.D., from the University of Waterloo, Canada, and colleagues. “This suggests that substantial improvements in medication use may be achieved through targeted, collaborative quality improvement initiatives in long-term care.”

Full findings were published in the June issue of JAMDA.