减少比利时养老院的精神药物使用：实施一项实践改进倡议。
Reducing Psychotropic Drug Use in Nursing Homes in Belgium: An Implementation Study for the Roll-Out of a Practice Improvement Initiative.
机构信息
Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
Centre for Research and Innovation in Care, University of Antwerp, Wilrijk, Belgium.
出版信息
Drugs Aging. 2019 Aug;36(8):769-780. doi: 10.1007/s40266-019-00686-5.
BACKGROUND AND OBJECTIVE
Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper.
METHODS
The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016-November 2017).
RESULTS
At baseline, participants' (n = 677) mean age was 85.6 years (range 54-109 years), with 72.6% female. Mean medication intake was 8.5 (range 1-22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522).
CONCLUSIONS
The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months.
背景与目的
在比利时的养老院中，精神药物的使用量很高。一项实践改进举措（包括教育、专业支持以及向以患者为中心的护理过渡）显著减少了精神药物的使用。该举措的概要被转录为一般干预模板，并随后在五家养老院（位于不同地点且性质各异）实施，为未来在比利时的更广泛推广做准备。本文报告了该干预措施对这五家养老院精神药物使用的影响。
方法
将一般干预模板应用于个别养老院环境。为养老院工作人员提供关于精神药物和非药物替代方案的教育，以及向以患者为中心的护理过渡的详细信息。使用动态队列研究设计进行精神药物使用的记录，同时进行横断面观察（2016 年 11 月至 2017 年 11 月）。
结果
在基线时，参与者（n=677）的平均年龄为 85.6 岁（范围 54-109 岁），其中 72.6%为女性。平均用药量为 8.5（范围 1-22），主要为中枢神经系统药物（解剖治疗化学分类 N，88.8%）。长期（>3 个月）使用精神药物（62.0%）和同时使用精神药物（31.5%同时使用两种或更多药物）的比例较高。12 个月后，长期使用精神药物的患病率显著下降（从 62.0%降至 52.9%，p<0.001），同时使用精神药物的比例也显著下降（从 31.5%降至 24.0%，p=0.001）。抗抑郁药和催眠镇静药使用的下降具有显著意义（分别从 32.2%降至 23.4%，p<0.001，和从 35.3%降至 28.7%，p=0.006），而抗精神病药物使用的下降无显著意义（从 17.1%降至 15.9%，p=0.522）。
结论
使用一般模板对先前报告的举措进行独立改编是可行的。该干预措施在 12 个月后显著降低了养老院居民的精神药物使用量（主要是催眠镇静药和抗抑郁药）。
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