None listed
Conditions
Brief summary
Antipsychotics are commonly prescribed for behavioural and psychological symptoms of dementia (BPSD) and delirium despite serious short and long term risks. Australian guidelines recommend limiting use in these situations to 12 weeks due to evidence of increase risk of stroke and sudden death with prolonged prescribing; however the prevalence of use beyond this time frame is high. A Macquarie University study cited at the 2020 Australian Royal Commission into Aged Care Quality and Safety, showed 65% (n=5825) of aged care facility residents prescribed antipsychotics for BPSD, remained on treatment for an average of 30 weeks. Pervasive and inappropriate use of antipsychotics (among other ‘restrictive practices’) was a key finding of the Royal Commission’s Interim Report, negatively impacting patient outcomes, quality and dignity of life. Reducing antipsychotic use requires multifactorial approaches including systems to support non-pharmacological interventions. Whilst not all of these are addressed in this study, increasing patient/carer understanding of evidence base and best practice use of antipsychotics addresses a key element, centered on patient/carer empowerment. This project aims to evaluate the impact of changes to hospital standard care, including increased GP and specific patient/carer engagement on the use of antipsychotics after hospital discharge. We predict it will have an impact of reducing antipsychotics prescribed (either dose or complete deprescribing) at 12 weeks after hospital discharge.
Interventions
This is a pre-post study involving 2 cohort of patients recruited during two separate 12week periods. The 'pre' phase is the control group, and the 'post' phase is the intervention group.
Participant allocation and recruitment:
All patients meeting the study selection criteria for each phase of the study will be invited to participate. Eligibility will be monitored by researchers to who have access to daily hospital patient lists and clinical information which will assist with flagging elig
This is a pre-post study involving 2 cohort of patients recruited during two separate 12week periods. The 'pre' phase is the control group, and the 'post' phase is the intervention group. Participant allocation and recruitment: All patients meeting the study selection criteria for each phase of the study will be invited to participate. Eligibility will be monitored by researchers to who have access to daily hospital patient lists and clinical information which will assist with flagging eligible patients for recruitment by pharmacists providing direct patient care. The 'control' group will receive standard usual care provided at this hospital: *provision of general verbal information to patients/carers from clinical pharmacists about antipsychotics prescribed at discharge. This is currently without emphasis on recommended duration of treatment. * provision of written information in the form of a Consumer Medicines Information sheet (TGA approved) * provision of a pharmacy generated "medication list" which lists all prescribed medicines at discharge. This list provides information on dosage and general indication for a medicine but for antipsychotics, does not specify details on recommended duration of treatment * medical teams do not routinely contact GP to discuss anti-psychotic prescribing and management plans For intervention phase patients, a suite of interventions in addition to standard clinical care will be provided. These are: At the time of hospital discharge, a clinical pharmacist will provide patients and/or their carers * increased and specific verbal information on the risk/benefits of antipsychotic use in dementia, post delirium and other related conditions, including best practice guidelines on the recommended duration of use. * written information from an established, reputable national (Australian) consumer focused organisation for Dementia (namely Dementia Australia but may include others), to support pharmacist provided information. Written information provided will come from material already available in the public domain * adjustment to Pharmacy Department generated "medication list" used as part of standard care, to re-iterate the added verbal and written information provided regarding antipsychotic use. Explicit recommendations for review of antipsychotics used beyond 12 weeks will be added to this list. After hospital discharge: A hospital medical officer (Senior Medical Registrar) will telephone the participants primary care physician (General Practitioner) within 1 week of hospital discharge to discuss participant's specific anti-psychotic treatment, hospital medical team’s prescribing and management intention (where initiated in hospital). Where deemed clinically appropriate for the patient, the hospital medical officer will provide a dose reduction or deprescribing plan to the GP for consideration and action. The dose reduction plan will be jointly generated by hospital medical officer and pharmacist, using a purposely designed de-prescribing template based on a peer reviewed algorithm (www.deprescribing.org). The GP will discuss and action the plan with the patient as part of ongoing primary care. Strategies to monitor adherence to the intervention will include: * a centralised database of all patients consented to the study * clinical documentation of telephone calls and transmission of deprescribing plan (via email or fax) to GP by the Senior Medical Registrar into the patients hospital medical records * documentation in the centralised study database when intervention is delivered and if attempts to contact GP fail, documentation of date(s) and follow up plan
Sponsors
Eastern Health
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Patients discharging from an inpatient admission under a General Medicine Unit (of the study organisation) to any address in the state of Victoria, Australia •Patients discharged with prescription of at least 1 oral antipsychotic (including ‘prn’- when required treatments) •Patient able to give informed consent OR consent provided by medical treatment decision maker
Exclusion criteria
• Patients with the following ICD-10 Classification of Mental and Behavioural Disorders: o F20-F29 - schizophrenia, schizotypal states and delusional disorders o F30-31 – manic episode, bipolar affective disorder o F40-F48 - Neurotic, stress-related and somatoform disorders o F02.3 - Dementia in Parkinson’s Disease
Outcome results
None listed