Format

Send to

Choose Destination
Age Ageing. 2019 Feb 26. pii: afz016. doi: 10.1093/ageing/afz016. [Epub ahead of print]

Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial.

Author information

1
Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
2
Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
3
Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
4
Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
5
mediStatistica, Neuenrade, Germany.
6
Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
7
Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
8
University Hospital Halle (Saale), Halle (Saale), Germany.

Abstract

BACKGROUND:

antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions.

OBJECTIVE:

we investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions.

DESIGN:

a 2-armed 12-month cluster-randomised controlled trial.

SETTING:

nursing homes in East, North and West Germany.

METHODS:

all prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation.

RESULTS:

the study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9-21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038-2.532).

CONCLUSIONS:

the implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02295462.

KEYWORDS:

antipsychotic agents; dementia; deprescriptions; nursing homes; older people; person-centred care

PMID:
30806453
DOI:
10.1093/ageing/afz016

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center