Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland; Department of Epidemiology and Public Health, University College Cork, Cork, Ireland; Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
J Am Med Dir Assoc. 2017 Oct 1;18(10):897.e1-897.e12. doi: 10.1016/j.jamda.2017.06.032. Epub 2017 Aug 12.
Antipsychotic prescribing is prevalent in nursing homes for the management of behavioral and psychological symptoms of dementia (BPSD), despite the known risks and limited effectiveness. Many studies have attempted to understand this continuing phenomenon, using qualitative research methods, and have generated varied and sometimes conflicting findings. To date, the totality of this qualitative evidence has not been systematically collated and synthesized.
To synthesize the findings from individual qualitative studies on decision-making and prescribing behaviors for antipsychotics in nursing home residents with dementia, with a view to informing intervention development and quality improvement in this field.
A systematic review and synthesis of qualitative evidence was conducted (PROSPERO protocol registration CRD42015029141). Six electronic databases were searched systematically from inception through July 2016 and supplemented by citation, reference, and gray literature searching. Studies were included if they used qualitative methods for both data collection and analysis, and explored antipsychotic prescribing in nursing homes for the purpose of managing BPSD. The Critical Appraisal Skills Program assessment tool was used for quality appraisal. A meta-ethnography was conducted to synthesize included studies. The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence in individual review findings. All stages were conducted by at least 2 independent reviewers.
Of 1534 unique records identified, 18 met the inclusion criteria. Five key concepts emerged as influencing decision-making: organizational capacity; individual professional capability; communication and collaboration; attitudes; regulations and guidelines. A "line of argument" was synthesized and a conceptual model constructed, comparing this decision-making process to a dysfunctional negative feedback loop. Our synthesis indicates that when all stakeholders come together to communicate and collaborate as equal and empowered partners, this can result in a successful reduction in inappropriate antipsychotic prescribing.
Antipsychotic prescribing in nursing home residents with dementia occurs in a complex environment involving the interplay of various stakeholders, the nursing home organization, and external influences. To improve the quality of antipsychotic prescribing in this cohort, a more holistic approach to BPSD management is required. Although we have found the issue of antipsychotic prescribing has been extensively explored using qualitative methods, there remains a need for research focusing on how best to change the prescribing behaviors identified.
尽管抗精神病药物治疗痴呆患者的行为和心理症状（BPSD）存在已知的风险和有限的疗效，但在养老院中仍广泛应用于治疗 BPSD。许多研究已经尝试使用定性研究方法来了解这一持续存在的现象，并得出了不同且有时相互矛盾的结果。迄今为止，尚未系统地整理和综合这些定性证据的总体情况。
综合关于养老院中痴呆患者使用抗精神病药物的决策和处方行为的单个定性研究的结果，以期为该领域的干预措施制定和质量改进提供信息。
对定性证据进行系统的综述和综合（PROSPERO 方案注册 CRD42015029141）。从创建开始通过 2016 年 7 月系统地搜索了六个电子数据库，并通过引用、参考文献和灰色文献搜索进行了补充。如果研究使用定性方法进行数据收集和分析，并且探索了养老院中使用抗精神病药物治疗 BPSD 的目的，则将其纳入研究。使用批判性评估技能计划评估工具进行质量评估。进行了元民族志以综合纳入的研究。使用从定性研究评估证据的置信度方法来评估单个综述结果的置信度。所有阶段都由至少 2 位独立评审员进行。
在 1534 个独特的记录中，有 18 个符合纳入标准。出现了五个影响决策的关键概念：组织能力；个人专业能力；沟通与协作；态度；规章制度。综合了一个“论点线”并构建了一个概念模型，将这一决策过程与功能失调的负反馈循环进行了比较。我们的综合表明，当所有利益相关者共同作为平等和有能力的合作伙伴进行沟通和协作时，这可以成功减少不适当的抗精神病药物处方。
在涉及各种利益相关者、养老院组织和外部影响相互作用的复杂环境中，养老院中痴呆患者的抗精神病药物处方是普遍存在的。为了提高这一人群中抗精神病药物处方的质量，需要采取更全面的方法来管理 BPSD。尽管我们已经发现使用定性方法广泛探索了抗精神病药物处方的问题，但仍需要研究如何最好地改变所确定的处方行为。
