Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) in Long-term Care Centers in Québec, Canada: A Strategy for Best Practices.

Abstract

OBJECTIVES:

Antipsychotic medications are often used for the first-line management of behavioral and psychological symptoms of dementia (BPSD) contrary to guideline recommendations. The Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) strategy aims to improve the well-being of long-term care (LTC) residents with major neurocognitive disorder (MNCD) by implementing a resident-centered approach, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications.

DESIGN:

Prospective, closed cohort supplemented by a developmental evaluation.

SETTING AND PARTICIPANTS:

Residents of designated wards in 24 LTC centers in Québec, Canada.

METHODS:

Provincial guidelines were disseminated, followed by the implementation of an integrated knowledge translation and mobilization strategy, including training, coaching, clinical tools, evaluation of clinical practices, and a change management strategy. Antipsychotic, benzodiazepine, and antidepressant prescriptions; BPSD; and falls were evaluated every 3 months, for 9 months, from January to October 2018. Semistructured interviews (n = 20) were conducted with LTC teams to evaluate the implementation of OPUS-AP.

RESULTS:

Of 1054 residents, 78.3% had an MNCD diagnosis and 51.7% an antipsychotic prescription. The cohort included 464 residents with both MNCD and antipsychotic prescription. Antipsychotic deprescribing (cessation or dose decrease) was attempted in 220 of the 344 residents still admitted at 9 months. Complete cessation was observed in 116 of these residents (52.7%) and dose reduction in 72 (32.7%), for a total of 188 residents (85.5%; 95% confidence interval: 80.1%, 89.8%). A decrease in benzodiazepine prescriptions and improvements in Cohen-Mansfield Agitation Inventory scores were observed among residents who had their antipsychotics deprescribed. Caregivers and clinicians expressed satisfaction as a result of observing an improved quality of life among residents.

CONCLUSIONS AND IMPLICATIONS:

Antipsychotic deprescribing was successful in a vast majority of LTC residents with MNCD without worsening of BPSD. Based on this success, phase 2 of OPUS-AP is now under way in 129 LTC centers in Québec.

• Authors: Benoit Cossette, Marie-Andrée Bruneau, Yves Couturier, Suzanne Gilbert, Diane Boyer, Jacques Ricard, Tanya McDonald, Karine Labarre, Véronique Déry, Marcel Arcand, Claudie Rodrigue, Andrée-Anne Rhéaume, Sylvie Moreault, Catherine Allard, Maude-Émilie Pépin, Olivier Beauchet, OPUS-AP investigators
• Journal: Journal of the American Medical Directors Association (J Am Med Dir Assoc) Vol. 21 Issue 2 Pg. 212-219 (02 2020) ISSN: 1538-9375 [Electronic] United States
• PMID: 31669289 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antipsychotic Agents

Topics

• Antipsychotic Agents (therapeutic use)
• Canada
• Dementia (drug therapy)
• Humans
• Long-Term Care
• Prospective Studies
• Quality of Life
• Quebec