Adherence to Guideline Recommendations on Psychotropic Drug Use for Challenging Behavior in Dementia

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY Journal of the American Medical Directors Association Pub Date : 2025-04-01 Epub Date: 2025-02-07 DOI:10.1016/j.jamda.2024.105474

Joury van der Griend MD , Fenne Wouters PhD , Gary Y.C. Yeung MD , Ineke J. Gerridzen MD, PhD , Karlijn J. Joling PhD , Sytse U. Zuidema MD, PhD , Martin Smalbrugge MD, PhD , Eefje M. Sizoo MD, PhD

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Abstract

Objective

Psychotropic drugs are frequently prescribed for challenging behavior in residents with dementia in nursing homes. Recommendations on psychotropic drug use for challenging behavior are described in the Dutch multidisciplinary guideline “Problem behavior in dementia.” This study aimed to gain insight into the adherence to guideline recommendations on drug type and timing of evaluations of different types of psychotropic drugs for challenging behavior in a national sentinel network of Dutch nursing homes.

Design

Prospective observational study.

Setting and Participants

Data on psychotropic drug use of residents in a sentinel network of 22 nursing homes across the Netherlands were collected during a 3-month measurement period in 2021.

Methods

Physicians completed registration forms integrated into the electronic health record after reporting on psychotropic drug use in progress notes. Prescribed drug type(s), type of drug intervention (start/stop/change in dosage/evaluation), and drug indications were recorded. Adherence to guideline recommendations on drug type was achieved if prescribed psychotropic drugs were recommended for the specified indication. Adherence to guideline recommendations on timing of evaluations was achieved if evaluations were reported within 7 days after starting.

Results

A total of 1279 forms on psychotropic drug use for specified challenging behaviors in 599 residents were collected. Recommended psychotropic drugs were used in 57% of all forms. The highest rate of recommended psychotropic drugs was for psychotic behavior (80%), followed by agitation (48%). Adherence was lowest for nighttime restlessness (22%). Of all newly started prescriptions, 17% were evaluated within the recommended 7 days after starting.

Conclusions and Implications

Adherence to guideline recommendations on drug type was present in just over half of the cases. Frequently, evaluations were not reported or were performed after the recommended time frame. Further research is needed to determine the reasons for non-recommended psychotropic drug use, low evaluation reporting rates, and factors that influence adherence. The use of a sentinel network may increase awareness and adherence.

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遵守精神药物用于痴呆患者挑战性行为的指南建议。

目的：精神科药物常用于治疗老年痴呆患者的行为挑战。荷兰多学科指南“痴呆症中的问题行为”中描述了使用精神药物治疗挑战性行为的建议。本研究旨在深入了解在荷兰养老院的国家哨点网络中，对不同类型精神药物的挑战性行为的药物类型和评估时间的指导建议的依从性。设计：前瞻性观察研究。环境和参与者：在2021年为期3个月的测量期间，收集了荷兰22家养老院哨点网络中居民的精神药物使用数据。方法：医生在进度记录中报告精神药物使用情况后，完成整合到电子健康记录中的登记表。记录处方药物种类、药物干预类型（开始/停止/改变剂量/评价）和药物适应证。如果处方精神药物被推荐用于特定的适应症，则达到了对药物类型指南建议的遵守。如果在开始后7天内报告评价，则实现了对评价时间指南建议的遵守。结果：共收集599名居民精神药物使用特定挑战性行为问卷1279份。所有形式中有57%使用了推荐的精神药物。推荐精神药物的比例最高的是精神病行为（80%），其次是躁动（48%）。依从性最低的是夜间不安（22%）。在所有新开处方中，17%在推荐的开处方后7天内进行评估。结论和意义：半数以上的病例遵守了指南中关于药物类型的建议。通常，评估没有报告或在建议的时间框架后执行。需要进一步的研究来确定非推荐精神药物使用的原因、低评估报告率和影响依从性的因素。哨兵网络的使用可以提高意识和依从性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Medical Directors Association 医学-老年医学

CiteScore

11.10

自引率

6.60%

发文量

472

审稿时长

44 days

期刊介绍： JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality