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Implementing a multidisciplinary psychotropic medication review among nursing home residents with dementia: a process evaluation

  • Debby L. Gerritsen (a1) (a2) (a3), Erica de Vries (a1), Martin Smalbrugge (a4), Claudia H. W. Smeets (a1) (a2) (a3), Klaas van der Spek (a1), Sytse U. Zuidema (a5) and Raymond T. C. M. Koopmans (a1) (a2) (a6)...



Before drawing conclusions on the contribution of an effective intervention to daily practice and initiating dissemination, its quality and implementation in daily practice should be optimal. The aim of this process evaluation was to study these aspects alongside a randomized controlled trial investigating the effects of a multidisciplinary biannual medication review in long-term care organizations (NTR3569).


Process evaluation with multiple measurements.


Thirteen units for people with dementia in six long-term care organizations in the Netherlands.


Physicians, pharmacists, and nursing staff of participating units.


The PROPER intervention is a structured and biannually repeated multidisciplinary medication review supported by organizational preparation and education, evaluation, and guidance.


Web-based questionnaires, interviews, attendance lists of education sessions, medication reviews and evaluation meetings, minutes, evaluation, and registration forms.


Participation rates in education sessions (95%), medication reviews (95%), and evaluation meetings (82%) were high. The intervention’s relevance and feasibility and applied implementation strategies were highly rated. However, the education sessions and conversations during medication reviews were too pharmacologically oriented for several nursing staff members. Identified barriers to implementation were required time, investment, planning issues, and high staff turnover; facilitators were the positive attitude of professionals toward the intervention, the support of higher management, and the appointment of a local implementation coordinator.


Implementation was successful. The commitment of both higher management and professionals was an important factor. This may partly have been due to the subject being topical; Dutch long-term-care organizations are pressed to lower inappropriate psychotropic drug use.


Corresponding author

Correspondence should be addressed to: Debby L. Gerritsen, Department of Primary and Community Care, Radboud University Medical Center, Code 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. Phone: +31 24 361 95 88. Email:


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Appelhof, B. et al. (2018). Process evaluation of an intervention for the management of neuropsychiatric symptoms in young-onset dementia. The Journal of the American Medical Directors Association, 19, 663671.
Buist, Y., Verbeek, H., De Boer, B. and de Bruin, S. R. (2018). Innovating dementia care; implementing characteristics of green care farms in other long-term care settings. International Psychogeriatrics, 30, 10571068.
Day, K., Kenealy, T. W. and Sheridan, N. F. (2016). Should we embed randomized controlled trials within action research: arguing from a case study of telemonitoring. BMC Medical Research Methodology, 16, 70.
Eldridge, S., Ashby, D., Bennett, C., Wakelin, M. and Feder, G. (2008). Internal and external validity of cluster randomised trials: systematic review of recent trials. BMJ, 336, 876880.
Elo, S. and Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62, 107115.
Francke, A. L., Smit, M. C., De Veer, A. J. and Mistiaen, P. (2008). Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Medical Informatics and Decision Making, 8, 38.
Glasgow, R. E., Klesges, L. M., Dzewaltowski, D. A., Estabrooks, P. A. and Vogt, T. M. (2006). Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Education Research, 21, 688694.
Gustafsson, M., Karlsson, S. and Lovheim, H. (2013). Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacology and Toxicology, 14, 10.
Hendriks, I., Meiland, F. J. M., Gerritsen, D. L. and Droes, R. M. (2018). Implementation and impact of unforgettable: an interactive art program for people with dementia and their caregivers. International Psychogeriatrics, 31, 351362.
Hulscher, M. E., Laurant, M. G. and Grol, R. P. (2003). Process evaluation on quality improvement interventions. Quality and Safety in Health Care, 12, 4046.
Janus, S. I., Van Manen, J. G., Mj, I. J. and Zuidema, S. U. (2016). Psychotropic drug prescriptions in Western European nursing homes. International Psychogeriatrics, 28, 17751790.
Koopmans, R., Pellegrom, M. and Van Der Geer, E. R. (2017). The Dutch move beyond the concept of nursing home physician specialists. The Journal of the American Medical Directors Association, 18, 746749.
Leontjevas, R., Gerritsen, D. L., Koopmans, R. T., Smalbrugge, M. and Vernooij-Dassen, M. J. (2012). Process evaluation to explore internal and external validity of the “Act in Case of Depression” care program in nursing homes. The Journal of the American Medical Directors Association, 13, 488 e18.
Leontjevas, R., Gerritsen, D. L., Smalbrugge, M., Teerenstra, S., Vernooij-Dassen, M. J. and Koopmans, R. T. (2013). A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial. Lancet, 381, 22552264.
Liberati, E. G., Gorli, M. and Scaratti, G. (2016). Invisible walls within multidisciplinary teams: disciplinary boundaries and their effects on integrated care. Social Science & Medicine, 150, 3139.
Loi, S. M., Mazur, A., Huppert, D., Hoy, B., Swan, J. and Lautenschlager, N. T. (2017). A pilot study using “apps” as a novel strategy for the management of challenging behaviors seen in people living in residential care. International Psychogeriatrics, 29, 637643.
Lucas, J. A. et al. (2014). Antipsychotic medication use in nursing homes: a proposed measure of quality. International Journal of Geriatric Psychiatry, 29, 10491061.
Mentes, J. C. and Tripp-Reimer, T. (2002). Barriers and facilitators in nursing home intervention research. Western Journal of Nursing Research, 24, 918936.
Resnick, B. (2013). Interdisciplinary interventions and teams are good…can we move beyond that? The Journal of the American Medical Directors Association, 14, 456458.
Rosemond, C. A., Hanson, L. C., Ennett, S. T., Schenck, A. P. and Weiner, B. J. (2012). Implementing person-centered care in nursing homes. Health Care Management Review, 37, 257266.
Rothwell, P. M. (2005). External validity of randomised controlled trials: “to whom do the results of this trial apply?” Lancet, 365, 8293.
Seitz, D. P. et al. (2013). Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review. International Psychogeriatrics, 25, 185203.
Sharkey, S., Hudak, S., Horn, S. D., Barrett, R., Spector, W. and Limcangco, R. (2013). Exploratory study of nursing home factors associated with successful implementation of clinical decision support tools for pressure ulcer prevention. Advances in Skin & Wound Care, 26, 8392; quiz p 93–94.
Smeets, C. H. et al. (2013). Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial. BMC Psychiatry, 13, 280.
Smeets, C. H. W. et al. (2017). Psychotropic drug prescription for nursing home residents with dementia: prevalence and associations with non-resident-related factors. Aging and Mental Health, 22, 12391246.
Steckler, A. B. and Linnan, L. (2002). Process Evaluation for Public Health Interventions and Research. San Francisco, CA: Jossey-Bass.
Tjia, J., Mazor, K. M., Field, T., Meterko, V., Spenard, A. and Gurwitz, J. H. (2009). Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety. Journal of Patient Safety, 5, 145152.
Tropea, J., Logiudice, D., Liew, D., Roberts, C. and Brand, C. (2017). Caring for people with dementia in hospital: findings from a survey to identify barriers and facilitators to implementing best practice dementia care. International Psychogeriatrics, 29, 467474.
Van Beek, A. P. and Gerritsen, D. L. (2010). The relationship between organizational culture of nursing staff and quality of care for residents with dementia: questionnaire surveys and systematic observations in nursing homes. International Journal of Nursing Studies, 47, 12741282.
Van Der Spek, K. et al. (2016). Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study. International Psychogeriatric, 28, 15891595.
Van Der Spek, K. et al. (2018). The effect of biannual medication reviews on the appropriateness of psychotropic drug use for neuropsychiatric symptoms in patients with dementia: a randomised controlled trial. Age and Ageing, 47, 430437.
Van Mierlo, L. D. et al. (2018). Facilitators and barriers to adaptive implementation of the Meeting Centers Support Program (MCSP) in three European countries; the process evaluation within the MEETINGDEM study. International Psychogeriatrics, 30, 527537.
Verkaik, R., Francke, A. L., Van Meijel, B., Ouwerkerk, J., Ribbe, M. W. and Bensing, J. M. (2011). Introducing a nursing guideline on depression in dementia: a multiple case study on influencing factors. International Journal of Nursing Studies, 48, 11291139.
Zwijsen, S. A., Smalbrugge, M., Eefsting, J. A., Gerritsen, D. L., Hertogh, C. M. and Pot, A. M. (2014a). Grip on challenging behavior: process evaluation of the implementation of a care program. Trials, 15, 302.
Zwijsen, S. A. et al. (2014b). Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia. The Journal of the American Medical Directors Association, 15, 531 e110.


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Implementing a multidisciplinary psychotropic medication review among nursing home residents with dementia: a process evaluation

  • Debby L. Gerritsen (a1) (a2) (a3), Erica de Vries (a1), Martin Smalbrugge (a4), Claudia H. W. Smeets (a1) (a2) (a3), Klaas van der Spek (a1), Sytse U. Zuidema (a5) and Raymond T. C. M. Koopmans (a1) (a2) (a6)...


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