Dissemination of Evidence‐Based Antipsychotic Prescribing Guidelines to Nursing Homes: A Cluster Randomized Trial. Issue 7 (14th July 2015)

• Record Type: Journal Article
• Authors: Tjia, Jennifer; Field, Terry; Mazor, Kathleen; Lemay, Celeste A.; Kanaan, Abir O.; Donovan, Jennifer L.; Briesacher, Becky A.; Peterson, Daniel; Pandolfi, Michelle; Spenard, Ann; Gurwitz, Jerry H.
• Is Part Of: Journal of the American Geriatrics Society. Volume 63:Issue 7(2015:Jul.)
• Page Start: 1289
• Page End: 1298
• Publication Date: 2015-07-14
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.13488
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs13488-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs13488-sec-0001" sec-type="section"> <title>Objectives</title> <p>To evaluate the effectiveness of efforts to translate and disseminate evidence‐based guidelines about atypical antipsychotic use to nursing homes (NHs).</p> </sec> <sec id="jgs13488-sec-0002" sec-type="section"> <title>Design</title> <p>Three‐arm, cluster randomized trial.</p> </sec> <sec id="jgs13488-sec-0003" sec-type="section"> <title>Setting</title> <p>NHs.</p> </sec> <sec id="jgs13488-sec-0004" sec-type="section"> <title>Participants</title> <p>NHs in the state of Connecticut.</p> </sec> <sec id="jgs13488-sec-0005" sec-type="section"> <title>Measurements</title> <p>Evidence‐based guidelines for atypical antipsychotic prescribing were translated into a toolkit targeting NH stakeholders, and 42 NHs were recruited and randomized to one of three toolkit dissemination strategies: mailed toolkit delivery (minimal intensity); mailed toolkit delivery with quarterly audit and feedback reports about facility‐level antipsychotic prescribing (moderate intensity); and in‐person toolkit delivery with academic detailing, on‐site behavioral management training, and quarterly audit and feedback reports (high intensity). Outcomes were evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE‐AIM) framework.</p> </sec> <sec id="jgs13488-sec-0006" sec-type="section"> <title>Results</title> <p>Toolkit awareness of 30% (7/23) of leadership of low‐intensity NHs, 54% (19/35) of moderate‐intensity NHs, and 82% (18/22) of high‐intensity NHs reflected adoption and implementation of the intervention. Highest levels of use and knowledge among direct care staff were reported in high‐intensity NHs. Antipsychotic prescribing levels declined during the study period, but there were no statistically significant differences between study arms or from secular trends.</p> </sec> <sec id="jgs13488-sec-0007" sec-type="section"> <title>Conclusion</title> <p>RE‐AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends. Further dissemination to external stakeholders such as psychiatry consultants and hospitals may be needed to influence antipsychotic prescribing for NH residents.</p> </sec> </abstract>