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Variability between nursing homes in prevalence of antipsychotic use in patients with dementia

Published online by Cambridge University Press:  20 November 2013

Bart C. Kleijer ,
Rob J. van Marum ,
Dinnus H. M. Frijters ,
Paul A. F. Jansen ,
Miel W. Ribbe ,
Antoine C. G. Egberts  and
Eibert R. Heerdink
Bart C. Kleijer
Affiliation:
Careyn Utrecht, Gerimedica, the Netherlands
Rob J. van Marum*
Affiliation:
Geriatric Department, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
Dinnus H. M. Frijters
Affiliation:
Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, the Netherlands EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
Paul A. F. Jansen
Affiliation:
Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
Miel W. Ribbe
Affiliation:
Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, the Netherlands EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
Antoine C. G. Egberts
Affiliation:
Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
Eibert R. Heerdink
Affiliation:
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
*
Correspondence should be addressed to: Rob van Marum, afdeling geriatrie, Jeroen Bosch Ziekenhuis, Postbus 90153, 5200 ME 's-Hertogenbosch, the Netherlands. Phone: +(31)73-553-8629; Fax: +(31)73-553-8555. Email: r.v.marum@jbz.nl.
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Abstract

Background:

Antipsychotic drugs (APD) are widely prescribed for people with dementia residing in long term care facilities (LTCFs). Concern has been expressed that such prescribing is largely inappropriate. The objective of this study is to examine if differences in facility-level prevalence of APD use in a sample of LTCFs for patients with dementia can be explained by patient and facility-related characteristics.

Methods:

A point prevalence study was conducted using data from the VU University Resident Assessment Instrument (VURAI) database from nursing homes and residential care facilities in the Netherlands. Patients were selected who had a diagnosis of dementia. LTCF and patient characteristics were extracted from the VURAI; facility-level resident satisfaction surveys were provided by the National Institute for Public Health.

Results:

In total, 20 LTCFs providing care for 1,090 patients with dementia were investigated. Overall, 31% of patients used an APD. In facilities with a high prevalence of APD use behavioral symptoms were present in 62% of their patients. In facilities with medium APD use behavioral problems remained frequent (57%), and in facilities with low prevalence of APD use 54% of the patients had behavioral symptoms. Facilities with a high prevalence of APD use were often large, situated in urban communities, and scored below average on staffing, personal care, and recreational activities.

Conclusions:

There was considerable variation between the participating LTCFs in the prevalence of APD use. Variability was related to LTCF characteristics and patient satisfaction. This indicates potential inappropriate prescribing because of differences in institutional prescribing culture.

Keywords

dementialong-term careneuropsychiatric symptomsnursing homesantipsychotics
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 3 , March 2014 , pp. 363 - 371
Copyright
Copyright © International Psychogeriatric Association 2013 

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