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Factors associated with appropriate psychotropic drug prescription in nursing home patients with severe dementia

Published online by Cambridge University Press:  21 September 2017

Klaas van der Spek ,
Raymond TCM Koopmans ,
Martin Smalbrugge ,
Marjorie HJMG Nelissen-Vrancken ,
Roland B Wetzels ,
Claudia HW Smeets ,
Steven Teerenstra ,
Sytse U Zuidema  and
Debby L Gerritsen
Klaas van der Spek*
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
Raymond TCM Koopmans
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands Joachim en Anna, center for specialized geriatric care, and Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
Martin Smalbrugge
Affiliation:
Department of General Practice and Elderly Care Medicine and Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
Marjorie HJMG Nelissen-Vrancken
Affiliation:
Dutch Institute for Rational Use of Medicine, Utrecht, The Netherlands
Roland B Wetzels
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
Claudia HW Smeets
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
Steven Teerenstra
Affiliation:
Department for Health Evidence, Group Biostatistics, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
Sytse U Zuidema
Affiliation:
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
Debby L Gerritsen
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands Radboud Alzheimer Centre, Nijmegen, The Netherlands
*
Correspondence should be addressed to: Klaas van der Spek, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, PO box 9101, 6500 HB Nijmegen, The Netherlands. Phone: +31641814811. E-mail: klaas.vanderspek@radboudumc.nl.
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Abstract

Background:

We studied the patient and non-patients factors of inappropriate psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home patients with severe dementia.

Methods:

In a cross-sectional study, the appropriateness of prescriptions was explored using the Appropriate Psychotropic drug use In Dementia (APID) index sum score. This index assesses information from medical records on indication, evaluation, dosage, drug–drug interactions, drug–disease interactions, duplications, and therapy duration. Various measurements were carried out to identify the possible patient and non-patient factors. Linear multilevel regression analysis was used to identify factors that are associated with APID index sum scores. Analyses were performed for groups of PDs separately, i.e. antipsychotics, antidepressants, anxiolytics, and hypnotics.

Results:

The sample consisted of 338 patients with a PD prescription that used 147 antipsychotics, 167 antidepressants, 85 anxiolytics, and 76 hypnotics. It was found that older patients and more severe aggression, agitation, apathy, and depression were associated with more appropriate prescriptions. Additionally, less appropriate prescriptions were found to be associated with more severe anxiety, dementia diagnoses other than Alzheimer dementia, more physician time available per patient, more patients per physician, more years of experience of the physician, and higher nurse's workload.

Conclusions:

The association of more pronounced NPS with more appropriate PD prescriptions implies that physicians should pay more attention to the appropriateness of PD prescriptions when NPS are less manifest. Non-patient-related factors are also associated with the appropriateness of PD prescriptions. However, especially considering that some of these findings are counter-intuitive, more research on the topic is recommended.

Keywords

dementiapsychopharmacologyneuropsychiatric symptoms
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 4: Issue Theme: Delirium , April 2018 , pp. 547 - 556
Copyright
Copyright © International Psychogeriatric Association 2017 

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