Clinical education intervention does not reduce antipsychotic prescribing in nursing homes
An academic detailing intervention was not associated with a significant reduction of antipsychotic prescribing in nursing homes, according to results of a cluster randomized clinical trial published in JAMA Network Open.
“Academic detailing in nursing homes may not be an effective intervention to reduce antipsychotic prescribing in an environment where standard quality improvement supports are working,” Mina Tadrous, PharmD, MS, PhD, of the Institute for Clinical Evaluative Sciences in Toronto, told Healio Psychiatry. “This study took place at a time when nursing homes were already receiving extensive audit and feedback and there was large media/public attention on the issue.”
Significant clinical, research and policy attention has focused on potentially inappropriate use of antipsychotics in nursing homes, particularly given their increased use during the early 2010s and the associated concern regarding their questionable effectiveness and well-established risk profile. Regulators have warned about harm associated with this drug class, with specific caution directed toward elderly patients prescribed antipsychotics because of their higher mortality rate.
Tadrous and colleagues sought to evaluate the effectiveness of academic detailing in nursing homes targeting appropriate antipsychotic prescribing. They defined academic detailing as “a method of educational outreach that leverages [one-on-one] interactions to communicate evidence-based information to clinicians.”
In the current trial, they compared the effect of usual care vs. academic detailing on prescribing antipsychotics among 40 nursing homes with 5,363 residents in Ontario. Health professionals, such as nurses or pharmacists, delivered academic detailing via meetings, presentations, group visits and one-on-one visits. From the time of launch, academic detailers maintained direct and ongoing contact with the nursing homes. Continuous dispensing of antipsychotics in the past week served as the primary outcome, and secondary outcomes included clinical outcomes and scores and prescribing of other psychotropic medications.
Participants in 18 intervention homes and 22 control homes had similar median ages of 86 and 85 years, respectively, and were of a similar sex (29.3% vs. 31.7% men).Results showed no statistically significant difference in the frequency of daily antipsychotic use (OR = 1.06; 95% CI, 0.93-1.2) among the groups at 12 months. Further, the researchers observed no significant differences in the rates of health care utilization; however, the intervention group exhibited statistically significant reductions in pain and depression compared with the control group at 6 months.
“Initially, we were surprised given the extensive evidence to support the effectiveness of academic detailing,” Tadrous told Healio Psychiatry. “Importantly, this work was part of a larger body of work that applied mixed methods, which helped us understand that although we saw no reduction in antipsychotic prescribing, there were other benefits that signaled improved care.”