Dissemination of Evidence-Based Antipsychotic Prescribing Guidelines to Nursing Homes: A Cluster Randomized Trial
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Antipsychotic Agents; Connecticut; Evidence-Based Medicine; Humans; Information Dissemination; *Nursing Homes; *Practice Guidelines as Topic; Practice Patterns, Physicians'
Geriatrics | Pharmacy and Pharmaceutical Sciences
OBJECTIVES: To evaluate the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs).
DESIGN: Three-arm, cluster randomized trial.
PARTICIPANTS: NHs in the state of Connecticut.
MEASUREMENTS: Evidence-based guidelines for atypical antipsychotic prescribing were translated into a toolkit targeting NH stakeholders, and 42 NHs were recruited and randomized to one of three toolkit dissemination strategies: mailed toolkit delivery (minimal intensity); mailed toolkit delivery with quarterly audit and feedback reports about facility-level antipsychotic prescribing (moderate intensity); and in-person toolkit delivery with academic detailing, on-site behavioral management training, and quarterly audit and feedback reports (high intensity). Outcomes were evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.
RESULTS: Toolkit awareness of 30% (7/23) of leadership of low-intensity NHs, 54% (19/35) of moderate-intensity NHs, and 82% (18/22) of high-intensity NHs reflected adoption and implementation of the intervention. Highest levels of use and knowledge among direct care staff were reported in high-intensity NHs. Antipsychotic prescribing levels declined during the study period, but there were no statistically significant differences between study arms or from secular trends.
CONCLUSION: RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends. Further dissemination to external stakeholders such as psychiatry consultants and hospitals may be needed to influence antipsychotic prescribing for NH residents.
antipsychotics, clinical trial, inappropriate drug use, nursing homes, quality of care
DOI of Published Version
J Am Geriatr Soc. 2015 Jul;63(7):1289-98. doi: 10.1111/jgs.13488. Epub 2015 Jul 14. Link to article on publisher's site
Journal of the American Geriatrics Society
Tjia, Jennifer; Field, Terry S.; Mazor, Kathleen M.; Lemay, Celeste A.; Kanaan, Abir O.; Donovan, Jennifer L.; Briesacher, Becky A.; Peterson, Daniel J.; Pandolfi, Michelle; Spenard, Ann; and Gurwitz, Jerry H., "Dissemination of Evidence-Based Antipsychotic Prescribing Guidelines to Nursing Homes: A Cluster Randomized Trial" (2015). University of Massachusetts Medical School Faculty Publications. 969.