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J Am Med Dir Assoc. 2019 Oct 25. pii: S1525-8610(19)30644-9. doi: 10.1016/j.jamda.2019.08.027. [Epub ahead of print]

Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) in Long-term Care Centers in Québec, Canada: A Strategy for Best Practices.

Author information

1
Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada; Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada. Electronic address: benoit.cossette@usherbrooke.ca.
2
Faculty of Medicine, Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada; Institut universitaire de gériatrie de Montréal research centre, Integrated University Health and Social Services Centre of the Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
3
Department of Social Work, University of Sherbrooke, Sherbrooke, Quebec, Canada; Québec Knowledge Network in Integrated Primary Health Care, Longueuil, Quebec, Canada.
4
Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
5
Integrated University Health and Social Services Centre of Estrie, Sherbrooke University Hospital Centre, Sherbrooke, Canada.
6
Integrated University Health and Social Services Centre of Estrie, Sherbrooke University Hospital Centre, Sherbrooke, Canada; Ministry of Health and Social Services, Quebec, Quebec, Canada.
7
Canadian Foundation for Healthcare Improvement, Ottawa, Ontario, Canada.
8
Résidence Humanitae, Quebec, Canada.
9
Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada.
10
Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada; Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada.
11
Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada.
12
Centre of Excellence on Aging of Quebec, Integrated University Health and Social Services Centre of the National Capital, Quebec, Quebec, Canada.
13
Centre Hospitalier Universitaire de Sherbrooke Research centre, Sherbrooke, Québec, Canada.
14
Research Centre on Aging, Integrated University Health and Social Services Centre of Estrie-Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada; School of Social Work, Faculty of Letters and Human Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada.
15
Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis, Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.

Abstract

OBJECTIVES:

Antipsychotic medications are often used for the first-line management of behavioral and psychological symptoms of dementia (BPSD) contrary to guideline recommendations. The Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) strategy aims to improve the well-being of long-term care (LTC) residents with major neurocognitive disorder (MNCD) by implementing a resident-centered approach, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications.

DESIGN:

Prospective, closed cohort supplemented by a developmental evaluation.

SETTING AND PARTICIPANTS:

Residents of designated wards in 24 LTC centers in Québec, Canada.

METHODS:

Provincial guidelines were disseminated, followed by the implementation of an integrated knowledge translation and mobilization strategy, including training, coaching, clinical tools, evaluation of clinical practices, and a change management strategy. Antipsychotic, benzodiazepine, and antidepressant prescriptions; BPSD; and falls were evaluated every 3 months, for 9 months, from January to October 2018. Semistructured interviews (n = 20) were conducted with LTC teams to evaluate the implementation of OPUS-AP.

RESULTS:

Of 1054 residents, 78.3% had an MNCD diagnosis and 51.7% an antipsychotic prescription. The cohort included 464 residents with both MNCD and antipsychotic prescription. Antipsychotic deprescribing (cessation or dose decrease) was attempted in 220 of the 344 residents still admitted at 9 months. Complete cessation was observed in 116 of these residents (52.7%) and dose reduction in 72 (32.7%), for a total of 188 residents (85.5%; 95% confidence interval: 80.1%, 89.8%). A decrease in benzodiazepine prescriptions and improvements in Cohen-Mansfield Agitation Inventory scores were observed among residents who had their antipsychotics deprescribed. Caregivers and clinicians expressed satisfaction as a result of observing an improved quality of life among residents.

CONCLUSIONS AND IMPLICATIONS:

Antipsychotic deprescribing was successful in a vast majority of LTC residents with MNCD without worsening of BPSD. Based on this success, phase 2 of OPUS-AP is now under way in 129 LTC centers in Québec.

KEYWORDS:

Antipsychotic; behavioral and psychological symptoms of dementia; dementia; deprescribing; long-term care; patient-centered care

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