Seniors Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
BMJ Open Qual. 2021 Apr;10(2). doi: 10.1136/bmjoq-2020-001211.
Antipsychotic medications are used to address neuropsychiatric symptoms associated with dementia. Evidence suggests that among older adults with dementia, their harms outweigh their benefits. A quality improvement initiative was conducted to address inappropriate antipsychotic medication use in long-term care (LTC) in the province of Alberta.
We conducted a multimethod evaluation of the provincial implementation of the project in 170 LTC sites over a 3-year project period incorporating a quasi-experimental before-after design. Using a three-component intervention of education and audit and feedback delivered in a learning workshop innovation collaborative format, local LTC teams were supported to reduce the number of residents receiving antipsychotic medications in the absence of a documented indication. Project resources were preferentially allocated to supporting sites with the highest baseline antipsychotic medication use. Changes in antipsychotic medication use, associated clinical and economic outcomes, and the effects of the project on LTC staff, physicians, leaders and administrators, and family members of LTC residents were assessed at the conclusion of the implementation phase.
The province-wide initiative was delivered with a 75% implementation fidelity. Inappropriate antipsychotic medication use declined from 26.8% to 21.1%. The decrease was achieved without unintended consequences in other outcomes including physical restraint use or aggressive behaviours. The project was more expensive but resulted in less inappropriate use of antipsychotics than the pre-project period (incremental cost per inappropriate antipsychotic avoided of $5 678.71). Accounts from family, organisational leaders, and LTC staff were supportive of the project activities and outcomes.
This quality improvement initiative was successfully delivered across an entire delivery arm of the continuing care sector. Quality of care in LTC was improved.
抗精神病药物用于治疗与痴呆相关的神经精神症状。有证据表明，在患有痴呆症的老年人中，他们的危害大于益处。在艾伯塔省，为了解决长期护理（LTC）中使用不当的抗精神病药物的问题，开展了一项质量改进计划。
我们在 3 年的项目期间，对该省在 170 个 LTC 场所实施该项目进行了多方法评估，采用了准实验前后设计。通过在学习工作坊创新合作模式下提供教育、审计和反馈的三部分干预措施，支持当地 LTC 团队减少没有记录的适应症的接受抗精神病药物治疗的居民数量。项目资源优先分配给基线抗精神病药物使用率最高的支持地点。在实施阶段结束时，评估了抗精神病药物使用的变化、相关的临床和经济结果以及该项目对 LTC 工作人员、医生、领导和管理人员以及 LTC 居民家属的影响。
全省范围的计划实施了 75%的实施保真度。不适当的抗精神病药物使用从 26.8%下降到 21.1%。在没有对其他结果产生意外后果的情况下实现了这一下降，包括身体约束的使用或攻击性行为。该项目成本更高，但与项目前相比，避免不必要使用抗精神病药物的成本更低（避免每例不适当使用抗精神病药物的增量成本为 5678.71 加元）。来自家庭、组织领导和 LTC 工作人员的意见支持项目活动和结果。
这项质量改进计划在整个持续护理部门成功实施。LTC 的护理质量得到了提高。
