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Assessment of antipsychotic prescribing in Belgian nursing

Majda Azermai, Monique Elseviers, Mirko Petrovic UGent, Lucas Van Bortel and Robert Vander Stichele UGent (2011) INTERNATIONAL PSYCHOGERIATRICS. 23(8). p.1240-1248
abstract
Background: Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes. Methods: Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP). Results: The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61-4.09), insomnia (OR: 1.38; 95% CI: 1.10-1.73), depression (OR: 1.30; 95% CI: 1.03-1.65), and age <80 years (OR: 1.79; 95% CI: 1.38-2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17). Conclusion: The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
prescribing quality indicators, inappropriate prescribing, antipsychotics, older adults, homes for the aged, PSYCHOTROPIC-DRUGS, RESIDENTS, MEDICATIONS, DEMENTIA, QUALITY, RISK
journal title
INTERNATIONAL PSYCHOGERIATRICS
Int. Psychogeriatr.
volume
23
issue
8
pages
1240 - 1248
Web of Science type
Article
Web of Science id
000295452900007
JCR category
PSYCHOLOGY, CLINICAL
JCR impact factor
2.24 (2011)
JCR rank
28/109 (2011)
JCR quartile
2 (2011)
ISSN
1041-6102
DOI
10.1017/S104161021100024X
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1888004
handle
http://hdl.handle.net/1854/LU-1888004
date created
2011-08-11 23:13:08
date last changed
2016-12-19 15:40:02
@article{1888004,
  abstract     = {Background: Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes. 
Methods: Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP). 
Results: The residents' mean age was 84.8 years, 78.1\% of whom were female. The prevalence of antipsychotic utilization was 32.9\%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95\% CI: 2.61-4.09), insomnia (OR: 1.38; 95\% CI: 1.10-1.73), depression (OR: 1.30; 95\% CI: 1.03-1.65), and age {\textlangle}80 years (OR: 1.79; 95\% CI: 1.38-2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6\%), use despite risk of falling (45.6\%), combined use with other psychotropics (31.8\%), and duplicate use (15.1\%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17). 
Conclusion: The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.},
  author       = {Azermai, Majda and Elseviers, Monique and Petrovic, Mirko and Van Bortel, Lucas and Vander Stichele, Robert},
  issn         = {1041-6102},
  journal      = {INTERNATIONAL PSYCHOGERIATRICS},
  keyword      = {prescribing quality indicators,inappropriate prescribing,antipsychotics,older adults,homes for the aged,PSYCHOTROPIC-DRUGS,RESIDENTS,MEDICATIONS,DEMENTIA,QUALITY,RISK},
  language     = {eng},
  number       = {8},
  pages        = {1240--1248},
  title        = {Assessment of antipsychotic prescribing in Belgian nursing},
  url          = {http://dx.doi.org/10.1017/S104161021100024X},
  volume       = {23},
  year         = {2011},
}

Chicago
Azermai, Majda, Monique Elseviers, Mirko Petrovic, Lucas Van Bortel, and Robert Vander Stichele. 2011. “Assessment of Antipsychotic Prescribing in Belgian Nursing.” International Psychogeriatrics 23 (8): 1240–1248.
APA
Azermai, M., Elseviers, M., Petrovic, M., Van Bortel, L., & Vander Stichele, R. (2011). Assessment of antipsychotic prescribing in Belgian nursing. INTERNATIONAL PSYCHOGERIATRICS, 23(8), 1240–1248.
Vancouver
1.
Azermai M, Elseviers M, Petrovic M, Van Bortel L, Vander Stichele R. Assessment of antipsychotic prescribing in Belgian nursing. INTERNATIONAL PSYCHOGERIATRICS. 2011;23(8):1240–8.
MLA
Azermai, Majda, Monique Elseviers, Mirko Petrovic, et al. “Assessment of Antipsychotic Prescribing in Belgian Nursing.” INTERNATIONAL PSYCHOGERIATRICS 23.8 (2011): 1240–1248. Print.