Behavioral and Psychiatric Symptoms of Dementia, Insomnia
Conditions
Keywords
sleep, antipsychotic, bpsd, deprescribing
Brief summary
The aim of this pilot study is to determine the feasibility of implementing an antipsychotic deprescribing initiative that is driven by pharmacists working collaboratively with the Program of All-inclusive Care for the Elderly (PACE) interdisciplinary team.
Detailed description
No individual antipsychotic has been approved by the U.S. Food and Drug Administration (FDA) for treating insomnia or behavioral and psychological symptoms of dementia (BPSD). Despite these medications being associated with significant harms, a considerable portion of older adults are prescribed antipsychotics for treatment of insomnia or BPSD. The aim of this study is to determine the feasibility of a pharmacist-driven antipsychotic deprescribing initiative in a community-based practice setting known as Program of All-inclusive Care for the Elderly (PACE). Our primary objective is to assess and describe the implementation process, including barriers and enablers to implementation. Our secondary objectives are to quantify and describe changes in antipsychotic prescribing following implementation; evaluate and report on antipsychotic re-initiations or changes in dosing; and evaluate and report on adverse drug withdrawal events (ADWEs) following antipsychotic deprescribing.
Interventions
Recommendation to Deprescribe
Sponsors
Tabula Rasa HealthCare
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
55 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Participant enrolled in a PACE organization during the implementation time period; * PACE organization contractually receiving pharmacy services from CareKinesis during the implementation time period; and, * Participant's prescriber determines that the participant could potentially benefit from deprescribing the antipsychotic.
Exclusion criteria
* A diagnosis of bipolar disorder, schizophrenia, schizo-affective disorder, acute delirium, Tourette's syndrome, tic disorders, autism, intellectual disability, developmental delay, obsessive-compulsive disorder, alcoholism, cocaine abuse, Parkinson's disease psychosis, or major depressive disorder for which the antipsychotic is specifically prescribed as adjunctive treatment; * Participant's prescriber determines that the participant would likely not benefit or could be harmed from deprescribing the antipsychotic; and, * Participant, or healthcare decision-maker on behalf of the participant (e.g., caregiver) refuses to participate in the deprescribing initiative.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Identify barriers and enablers to implementation of antipsychotic deprescribing initiative. | Three months | Qualitative |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Implement changes in antipsychotic prescribing to patients in the PACE population. | Three months | Quantitative and Qualitative |
| Measure the number of antipsychotic re-initiations in the PACE population. | Three months | Quantitative |
| Measure changes in antipsychotic dosing for the PACE population. | Three months | Quantitative |
| Identify the number of adverse drug withdrawal events (ADWEs) in the PACE population. | Three months | Quantitative and Qualitative |
Countries
United States
Outcome results
None listed