@article {11, title = {Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial.}, journal = {Implement Sci}, volume = {10}, year = {2015}, month = {2015 Jun 04}, pages = {82}, abstract = {

BACKGROUND: The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions.

METHODS/DESIGN: The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12~months of follow-up. Secondary outcomes are residents{\textquoteright} quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study.

DISCUSSION: To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT02295462.

}, keywords = {Accidental Falls, Antipsychotic Agents, Costs and Cost Analysis, Dementia, Drug Utilization, Germany, Homes for the Aged, Humans, Inservice Training, Mental Disorders, Nursing Homes, Patient-Centered Care, Psychomotor Agitation, Quality of Life, Research Design}, issn = {1748-5908}, doi = {10.1186/s13012-015-0268-3}, author = {Richter, Christin and Berg, Almuth and Fleischer, Steffen and K{\"o}pke, Sascha and Balzer, Katrin and Fick, Eva-Maria and S{\"o}nnichsen, Andreas and L{\"o}scher, Susanne and Vollmar, Horst Christian and Haastert, Burkhard and Icks, Andrea and Dintsios, Charalabos-Markos and Mann, Eva and Wolf, Ursula and Meyer, Gabriele} } @article {20, title = {Prevalence of psychotropic medication use among German and Austrian nursing home residents: a comparison of 3 cohorts.}, journal = {J Am Med Dir Assoc}, volume = {13}, year = {2012}, month = {2012 Feb}, pages = {187.e7-187.e13}, abstract = {

BACKGROUND: Despite increasing knowledge about the limited effectiveness and severe adverse effects, the prescription rate of psychotropic medications in frail elderly persons remains high. Prescriptions are mainly made to control behavioral and psychological symptoms of dementia, although factors associated with prescriptions are rarely reported. However, such information is a prerequisite to develop intervention programs aiming to safely reduce psychotropic medication in nursing home residents.

METHODS: We report the comparison of cross-sectional data of psychotropic medication prescription rates from 3 large studies including nursing home residents in Germany and Austria. We aimed to compare the prevalence of (1) psychotropic medication, (2) different classes of psychotropic medication, (3) psychotropic medication administered for bedtime use, and (4) associations between prescription of psychotropics and institutional and residents{\textquoteright} characteristics. Confidence intervals of prevalences and multiple logistic regression analyses were adjusted for cluster correlation.

RESULTS: Data from 5336 residents in 136 long term care facilities were included. In Austria, 74.6\% (95\% CI 72.0-77.2\%) of all residents had a prescription of at least one psychotropic medication compared to Germany with about 51.8\% (95\% CI 48.3-55.2\%) and 52.4\% (95\% CI 48.7-56.1\%). Of all antipsychotics, 66\% (Austria) and 47\% (Germany) were prescribed for bedtime use. Most prescriptions were conventional, low-potency antipsychotics. In all 3 studies, there was no statistically significant association between psychotropic medication prescription and nursing home characteristics. On the level of residents, consistent positive associations were found for higher level of care dependency and permanent restlessness. Consistent negative associations were found for older age and male gender.

CONCLUSION: Frequency of psychotropic and especially antipsychotic medication is substantial in nursing home residents in Germany and Austria. The high number of prescriptions is likely to be an indicator for a perceived or actual lack of strategies to handle behavioral and psychological symptoms of dementia.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Austria, Cluster Analysis, Cross-Sectional Studies, Dementia, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Utilization, Female, Geriatric Assessment, Germany, Homes for the Aged, Humans, Logistic Models, Long-Term Care, Male, Nursing Homes, Prevalence, Psychotropic Drugs, Risk Assessment, Sex Distribution}, issn = {1538-9375}, doi = {10.1016/j.jamda.2011.03.007}, author = {Richter, Tanja and Mann, Eva and Meyer, Gabriele and Haastert, Burkhard and K{\"o}pke, Sascha} } @article {25, title = {Psychotropic medication use among nursing home residents in Austria: a cross-sectional study.}, journal = {BMC Geriatr}, volume = {9}, year = {2009}, month = {2009 May 21}, pages = {18}, abstract = {

BACKGROUND: The use of psychotropic medications and their adverse effects in frail elderly has been debated extensively. However, recent data from European studies show that these drugs are still frequently prescribed in nursing home residents. In Austria, prevalence data are lacking. We aimed to determine the prevalence of psychotropic medication prescription in Austrian nursing homes and to explore characteristics associated with their prescription.

METHODS: Cross-sectional study and association analysis in forty-eight out of 50 nursing homes with 1844 out of a total of 2005 residents in a defined urban-rural region in Austria. Prescribed medication was retrieved from residents{\textquoteright} charts. Psychotropic medications were coded according to the Anatomical Therapeutic Chemical Classification 2005. Cluster-adjusted multiple logistic regression analysis was performed to investigate institutional and residents{\textquoteright} characteristics associated with prescription.

RESULTS: Residents{\textquoteright} mean age was 81; 73\% of residents were female. Mean cluster-adjusted prevalence of residents with at least one psychotropic medication was 74.6\% (95\% confidence interval, CI, 72.0-77.2). A total of 45.9\% (95\% CI 42.7-49.1) had at least one prescription of an antipsychotic medication. Two third of all antipsychotic medications were prescribed for bedtime use only. Anxiolytics were prescribed in 22.2\% (95\% CI 20.0-24.5), hypnotics in 13.3\% (95\% CI 11.3-15.4), and antidepressants in 36.8\% (95\% CI 34.1-39.6) of residents. None of the institutional characteristics and only few residents{\textquoteright} characteristics were significantly associated with psychotropic medication prescription. Permanent restlessness was positively associated with psychotropic medication prescription (AOR 1.54, 95\% CI 1.32-1.79) whereas cognitive impairment was inversely associated (AOR 0.70, 95\% CI 0.56-0.88).

CONCLUSION: Frequency of psychotropic medication prescription is high in Austrian nursing homes compared to recent published data from other countries. Interventions should aim at reduction and optimisation of prescriptions.

}, keywords = {Adult, Aged, Aged, 80 and over, Austria, Cross-Sectional Studies, Female, Homes for the Aged, Humans, Male, Middle Aged, Nursing Homes, Psychotropic Drugs}, issn = {1471-2318}, doi = {10.1186/1471-2318-9-18}, author = {Mann, Eva and K{\"o}pke, Sascha and Haastert, Burkhard and Pitk{\"a}l{\"a}, Kaisu and Meyer, Gabriele} }