Ellis Michelle L, Molinari Victor, Dobbs Debra, Smith Kelly, Hyer Kathryn
School of Aging Studies, University of South Florida, Tampa, Florida; Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida.
Aging Ment Health. 2015;19(6):507-16. doi: 10.1080/13607863.2014.952710. Epub 2014 Aug 28.
Antipsychotic medications have been federally regulated since 1987, yet research suggests they continue to be used inappropriately to alleviate behavioral symptoms associated with dementia. In 2012, the Centers of Medicare and Medicaid launched a new initiative to reduce antipsychotic medication in nursing homes by 15% nationally. The aim of this study was to examine qualitative data to explore strategies that have been implemented, to assess which strategies are evidence-based, and to make recommendations to improve upon practices to reduce antipsychotic medication use.
A convenience sample of 276 nursing home professional staff members were surveyed about these topics using open-ended questions.
Theme-based content analysis yielded three main themes. The themes related to changes in practice included the following: (1) increased review of resident behavior and antipsychotic medication regimens; (2) reduction in antipsychotic medications or dosage; and (3) increased use of nonpharmacological interventions. The main themes relevant to needed assistance included the following: (1) education; (2) clinical support; and (3) increased financial resources and reimbursement.
Overall findings indicate that the majority of facilities are actively responding to the initiative, but challenges remain in education, finding mental health support, and in reimbursement.
自1987年以来，抗精神病药物一直受到联邦监管，但研究表明，它们仍被不恰当地用于缓解与痴呆症相关的行为症状。2012年，医疗保险和医疗补助服务中心发起了一项新倡议，目标是在全国范围内将疗养院中抗精神病药物的使用量减少15%。本研究的目的是审查定性数据，以探索已实施的策略，评估哪些策略是基于证据的，并提出改进措施的建议，以减少抗精神病药物的使用。
使用开放式问题对276名疗养院专业工作人员进行了便利抽样调查，询问了这些主题。
基于主题的内容分析产生了三个主要主题。与实践变化相关的主题包括：（1）加强对居民行为和抗精神病药物治疗方案的审查；（2）减少抗精神病药物或剂量；（3）增加非药物干预措施的使用。与所需援助相关的主要主题包括：（1）教育；（2）临床支持；（3）增加财政资源和报销。
总体研究结果表明，大多数机构正在积极响应该倡议，但在教育、寻找心理健康支持和报销方面仍存在挑战。
