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BMC Psychiatry
Published in: BMC Psychiatry 1/2013

Open Access 01-12-2013 | Study protocol

PROPER I: frequency and appropriateness of psychotropic drugs use in nursing home patients and its associations: a study protocol

Authors: Klaas van der Spek, Debby L Gerritsen, Martin Smalbrugge, Marjorie HJMG Nelissen-Vrancken, Roland B Wetzels, Claudia HW Smeets, Sytse U Zuidema, Raymond TCM Koopmans

Published in: BMC Psychiatry | Issue 1/2013

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Abstract

Background

Nursing home patients with dementia use psychotropic drugs longer and more frequently than recommended by guidelines implying psychotropic drugs are not always prescribed appropriately. These drugs can have many side effects and effectiveness is limited. Psychotropic drug use between nursing home units varies and is not solely related to the severity of neuropsychiatric symptoms. There is growing evidence indicating that psychotropic drug use is associated with environmental factors, suggesting that the prescription of psychotropic drugs is not only related to (objective) patient factors. However, other factors related to the patient, elderly care physician, nurse and the physical environment are only partially identified. Using a mixed method of qualitative and quantitative research, this study aims to understand the nature of psychotropic drug use and its underlying factors by identifying: 1) frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms in nursing home patients with dementia, 2) factors associated with (appropriateness of) psychotropic drug use.

Methods

A cross-sectional mixed methods study. For the quantitative study, patients with dementia (n = 540), nursing staff and elderly care physicians of 36 Dementia Special Care Units of 12 nursing homes throughout the Netherlands will be recruited. Six nursing homes with high average rates and six with low average rates of psychotropic drug use, based on a national survey about frequency of psychotropic drug use on units, will be included. Psychotropic drugs include antipsychotics, anxiolytics, hypnotics, antidepressants, anticonvulsants and anti-dementia drugs. Appropriateness will be measured by an instrument based on the Medication Appropriateness Index and current guidelines for treatment of neuropsychiatric symptoms. Factors associated to psychotropic drug use, related to the patient, elderly care physician, nurse and physical environment, will be explored using multilevel regression analyses. For the qualitative study, in depth interviews with staff will be held and analyzed to identify and explore other unknown factors.

Discussion

This study will provide insight into factors that are associated with the frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms. Understanding psychotropic drug use and its associations may contribute to better dementia care.
Appendix
Available only for authorised users
Literature
1.
Health Council of the Netherlands: Dementia. 2002, The Hague: Health Council of the Netherlands, publication no. 2002/04
2.
3.
Zuidema SU, Derksen E, Verhey FRJ, Koopmans RTCM: Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. Int J Geriatr Psychiatry. 2007, 22: 632-638. 10.1002/gps.1722.CrossRefPubMed
4.
Cornegé-Blokland E, Kleijer BC, Hertogh CMPM, van Marum RJ: Reasons to prescribe antipsychotics for the behavioral symptoms of dementia: a survey in Dutch nursing homes among physicians, nurses, and family caregivers. J Am Med Dir Assoc. 2010, 13: 1-7.
5.
Wood-Mitchell A, James IA, Waterworth A, Swann A, Ballard C: Factors influencing the prescribing of medications by old age psychiatrists for behavioural and psychological symptoms of dementia: a qualitative study. Age Ageing. 2008, 37: 547-552. 10.1093/ageing/afn135.CrossRefPubMed
6.
Nijk RM, Zuidema SU, Koopmans RTCM: Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. International Psychogeriatrics / IPA. 2009, 21: 485-493. 10.1017/S1041610209008916.CrossRefPubMed
7.
Enmarker I, Olsen R, Hellzen O: Management of person with dementia with aggressive and violent behaviour: a systematic literature review. Int J Older People Nurs. 2011, 6: 153-162. 10.1111/j.1748-3743.2010.00235.x.CrossRefPubMed
8.
Selbaek G, Kirkevold Ø, Engedal K: The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry. 2007, 22: 843-849. 10.1002/gps.1749.CrossRefPubMed
9.
Wetzels RB, Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM: Prescribing pattern of psychotropic drugs in nursing home residents with dementia. International Psychogeriatrics / IPA. 2011, 23: 1249-1259. 10.1017/S1041610211000755.CrossRefPubMed
10.
Feng Z, Hirdes JP, Smith TF, Finne-soveri H, Chi I, Du Pasquier J, Gilgen R, Ikegami N, Mor V: Use of physical restraints and antipsychotic medications in nursing homes: a cross-national study. Int J Geriatr Psychiatry. 2008, 2009: 1110-1118.
11.
Testad I, Auer S, Mittelman M, Ballard C, Fossey J, Donabauer Y, Aarsland D: Nursing home structure and association with agitation and use of psychotropic drugs in nursing home residents in three countries: Norway, Austria and England. Int J Geriatr Psychiatry. 2010, 25: 725-731.CrossRefPubMed
12.
Nygaard HA, Brudvik E, Juvik OB, Pedersen WE, Rotevatn TS, Vollset A: Consumption of psychotropic-drugs in nursing-home residents - a prospective-study in patients permanently admitted to a nursing-home. Int J Geriatr Psychiatry. 1994, 9: 387-391. 10.1002/gps.930090507.CrossRef
13.
Van Iersel MB, Zuidema SU, Koopmans RT, Verhey FR: ORM: antipsychotics for behavioural and psychological problems in elderly people with dementia: a systematic review of adverse events. Drugs Aging. 2005, 22: 845-858. 10.2165/00002512-200522100-00004.CrossRefPubMed
14.
Schneider LS, Dagerman KIP: Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry. 2006, 14: 191-210. 10.1097/01.JGP.0000200589.01396.6d.CrossRefPubMed
15.
Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, Gill R, Juszczak E, Yu L-M, Jacoby R: The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol. 2009, 8: 151-157. 10.1016/S1474-4422(08)70295-3.CrossRefPubMed
16.
Uzun S, Kozumplik O, Jakovljevic M, Sedic B: Side effects of treatment with benzodiazepines. Psychiatr Danub. 2010, 22: 90-93.PubMed
17.
Wetzels RB, Zuidema SU, De Jonghe JFM, Verhey FRJ, Koopmans RTCM: Determinants of quality of life in nursing home residents with dementia. Dement Geriatr Cogn Disord. 2010, 29: 189-197. 10.1159/000280437.CrossRefPubMed
18.
Ballard C, OBrien J, James I, Mynt P, Lana M, Potkins D, Reichelt K, Lee L, Swann A, Fossey J: Quality of Life for People With Dementia Living in Residential and Nursing Home Care: The Impact of Performance on Activities of Daily Living, Behavioral and Psychological Symptoms, Language Skills, and Psychotropic Drugs. Int Psychogeriatr. 2001, 13: 93-106. 10.1017/S1041610201007499.CrossRefPubMed
19.
Gustafsson M, Karlsson S, Lövheim H: Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacol Toxicol. 2013, 14: 10-10.1186/2050-6511-14-10.CrossRefPubMedPubMedCentral
20.
Van Dijk KN, de Vries CS, van den Berg PB, et al: Drug utilisation in Dutch nursing homes. Eur J Clin Pharmacol. 2000, 55: 765-771. 10.1007/s002280050012.CrossRefPubMed
21.
Zuidema SU, De Jonghe JFM, Verhey FRJ, Koopmans RTCM: Neuropsychiatric symptoms in nursing home patients: factor structure invariance of the Dutch nursing home version of the neuropsychiatric inventory in different stages of dementia. Dement Geriatr Cogn Disord. 2007, 24: 169-176. 10.1159/000105603.CrossRefPubMed
22.
Bustin J: Atypical antipsychotics and CATIE-AD. Is this a turning point?. Vertex. 2009, 20: 136-143.PubMed
23.
Smalbrugge M, Boersma F, Kleijer BC, Kok RM, Sival RC, Verburg D, Verheij FRJ, Zuidema SU: Guideline problem behavior, NVVA. 2008
24.
Chen Y, Briesacher BA, Field TS, Tjia J, Lau DT, Gurwitz JH: Unexplained variation across US nursing homes in antipsychotic prescribing rates. Arch Intern Med. 2010, 170: 89-95. 10.1001/archinternmed.2009.469.CrossRefPubMedPubMedCentral
25.
Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM: Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior. Int Psychogeriatr. 2011, 23: 1-8. 10.1017/S1041610210000992.CrossRef
26.
Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM: Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia. Int J Geriatr Psychiatry. 2010, 25: 14-22.PubMed
27.
Kamble P, Chen H, Sherer JT, Aparasu RR: Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data. Drugs Aging. 2009, 26: 483-492. 10.2165/00002512-200926060-00005.CrossRefPubMed
28.
Smeets CH, Smalbrugge M, Gerritsen DL, Nelissen-Vrancken MH, Wetzels RB, van der Spek K, Zuidema SU, Koopmans RT: Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial. BMC Psychiatry. 2013, 13 (1): 280-10.1186/1471-244X-13-280.CrossRefPubMedPubMedCentral
29.
Nordic Council on Medicines: Guidelines for ATC classification. 1990, Oslo: WHO Collaborating Center for Drugs Statistics Methodology
30.
Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, Cohen HJ, Feussner JR: A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992, 45: 1045-1051. 10.1016/0895-4356(92)90144-C.CrossRefPubMed
31.
Luo R, Scullin C, Mullan AMP, Scott MG, McElnay JC: Comparison of tools for the assessment of inappropriate prescribing in hospitalized older people. J Eval Clin Pract. 2011, 18: 1-7.
32.
Stuijt CCM, Franssen EJF, Egberts ACG, Hudson SA: Appropriateness of prescribing among elderly patients in a Dutch residential home: observational study of outcomes after a pharmacist-led medication review. Drugs Aging. 2008, 25: 947-954. 10.2165/0002512-200825110-00005.CrossRefPubMed
33.
34.
35.
36.
Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, Lopez OL, DeKosky ST: Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci. 2000, 12: 233-239. 10.1176/appi.neuropsych.12.2.233.CrossRefPubMed
37.
de Jonghe JF, Kat MG, Kalisvaart CJ: Neuropsychiatric inventory questionnaire (NPI-Q): A validity study of the Dutch form. Tijdschr Gerontol Geriatr. 2003, 34: 74-77.PubMed
38.
Cohen-Mansfield J, Billig N: Agitated behaviors in the elderly I. A conceptual review. J Am Geriatr Soc. 1986, 34: 711-721.CrossRefPubMed
39.
Zuidema SU, Buursema AL, Gerritsen MGJM, Oosterwal KC, Smits MMM, Koopmans RTCM, de Jonghe JFM: Assessing neuropsychiatric symptoms in nursing home patients with dementia: reliability and reliable change index of the neuropsychiatric inventory and the cohen-mansfield agitation inventory. Int J Geriatr Psychiatry. 2011, 26: 127-134. 10.1002/gps.2499.CrossRefPubMed
40.
Zuidema SU, Derksen E, Verhey FRJ, Koopmans RTCM: Prevalence and predictors of neuropsychiatric symptoms in cognitively impaired nursing home patients. J Geriatr Psychiatry Neurol. 2007, 20: 632-638.CrossRef
41.
Lintern T: Quality in Dementia Care: Evaluating Staff Attitudes and Behaviour. 2001, University of Wales Bangor, 15-16. 20
42.
Scott-Cawiezell J, Jones K, Moore L, Vojir C: Nursing home culture: a critical component in sustained improvement. J Nurs Care Qual. 2005, 20: 341-348. 10.1097/00001786-200510000-00010.CrossRefPubMed
43.
Van Beek APA, Gerritsen DL: The relationship between organizational culture of nursing staff and quality of care for residents with dementia: questionnaire surveys and systematic observations in nursing homes. Int J Nurs Stud. 2010, 47: 1274-1282. 10.1016/j.ijnurstu.2010.02.010.CrossRefPubMed
44.
Cameron KFS: Culture, congruence, strenght and type: relationship to effectiveness. Res Org Change Dev. 1991, 5: 23-58.
45.
de Jonge J, Landeweerd JA: Toetsing van de Job Demand-Control benadering bij werknemers Demand-Control, in de gezondheidszorg: een secundaire data-analyse [Testing of the Job approach among health care workers: a secondary analysis]. Gedrag en Organisatie. 1993, 6: 79-92.
46.
Vermaat K: Flexibele werklastbeheersing in de verpleging[Flexible workload control in nursing]. 1994, Maastricht: Universty of Limburg
47.
Landeweerd JA, Boumans NPG, Nissen JMF: Arbeidsvoldoening bij verplegenden en verzorgenden. De Maastrichtse arbeidssatisfactieschaal voor de gezondheidszorg. [Job satisfaction of nurses and CNAs. The Maastricht Work Satisfaction Scale for Healthcare]. Handboek Verpleegkundige Innovatie. Edited by: Van Beek CC, Van Dorsten TG, Stam GJ. 1996, Houten: Bohn Stafleu
48.
Sloane PD, Mitchell CM, Weisman G, Zimmerman S, Foley KML, Lynn M, Calkins M, Lawton MP, Teresi J, Grant L, Lindeman D, Montgomery R: The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): an observational instrument for assessing the physical environment of institutional settings for persons with dementia. J Gerontol B Psychol Sci Soc Sci. 2002, 57: S69-S78. 10.1093/geronb/57.2.S69.CrossRefPubMed
49.
Cooney A: Choosing between Glaser and Strauss: an example. Nurse Res. 2010, 17: 18-28. 10.7748/nr2010.07.17.4.18.c7921.CrossRefPubMed
50.
Strauss A, Corbin J: Basics of Qualitative Research. 2008, Sage: Thousand Oaks, CA, 379-3
51.
Strauss ACJ: Basics of qualitative research; Grounded theory procedures and techniques. 1990, London: Sage
52.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR: A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996, 49: 1373-1379. 10.1016/S0895-4356(96)00236-3.CrossRefPubMed
53.
Peduzzi P, Concato J, Feinstein AR, Holford TR: Importance of Events Per Independent Variable in Proportional Hazards Regression Analysis. II. Accuracy and Precision of Regression Estimates. J Clin Epidemiol. 1995, 48: 1503-1510. 10.1016/0895-4356(95)00048-8.CrossRefPubMed
Metadata
Title
PROPER I: frequency and appropriateness of psychotropic drugs use in nursing home patients and its associations: a study protocol
Authors
Klaas van der Spek
Debby L Gerritsen
Martin Smalbrugge
Marjorie HJMG Nelissen-Vrancken
Roland B Wetzels
Claudia HW Smeets
Sytse U Zuidema
Raymond TCM Koopmans
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2013
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-13-307

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