Tailored interventions for inappropriate psychotropic drug use in nursing home residents with dementia: participatory action research in a special case of a stepped-wedge cluster randomized controlled trial
Abstract Background Psychotropic drugs are modestly effective and may cause adverse effects. Efforts to reduce inappropriateness and increase usage of psychosocial interventions often suffer from suboptimal implementation. The purpose of this study was to evaluate effectiveness of an innovative stud...
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BMC
2025-08-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-06206-y |
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| author | Claudia M. Groot Kormelinck Debby L. Gerritsen Charlotte F. van Teunenbroek Michiel R. de Boer Martin Smalbrugge Sytse U. Zuidema |
| author_facet | Claudia M. Groot Kormelinck Debby L. Gerritsen Charlotte F. van Teunenbroek Michiel R. de Boer Martin Smalbrugge Sytse U. Zuidema |
| author_sort | Claudia M. Groot Kormelinck |
| collection | DOAJ |
| description | Abstract Background Psychotropic drugs are modestly effective and may cause adverse effects. Efforts to reduce inappropriateness and increase usage of psychosocial interventions often suffer from suboptimal implementation. The purpose of this study was to evaluate effectiveness of an innovative study using implementation promoting elements in nursing home residents with dementia and neuropsychiatric symptoms. Methods A multicenter cluster randomized controlled trial with a special case of a stepped-wedge design with two arms and one stap was designed. The intervention comprised participatory action research, tailored information provision and external coaching, leading to the implementation of tailored action and implementation plans. The primary outcome was inappropriateness of psychotropic drug use (Appropriate Psychotropic Drug Use in Dementia [APID] index) and the secondary outcome was percentage of psychotropic drug use at baseline, 8 months, and 16 months. Homes were allocated to start with usual care or the intervention. After 8 months, the control group crossed over to receive the intervention. The other homes continued the intervention to 16 months. Patients were eligible if they were diagnosed with dementia, had a life expectancy of at least 3 months, and resided in psychogeriatric units. Results An adjusted multilevel model revealed no effect on the APID index sum score at 8 months (0.564; 95% confidence interval [CI], -2.449–3.577; p = 0.71) or 16 months (2.165; 95% CI, -1.113–5.443; p = 0.20). An adjusted generalized estimation equation (GEE) model showed an effect at 16 months for percentage of use (OR 0.654; 95% CI, 0.481–0.889; p = 0.007). Adjusted GEE models showed an effect especially at 16 months for anxiolytics (OR 0.573; 95% CI, 0.382–0.859; p = 0.007) and antidepressants (OR 0.678; 95% CI, 0.475–0.968; p = 0.033). Conclusions No reduction of inappropriateness was found although overall usage was reduced. Professionals focused on implementing alternatives to compensate for usage, rather than prescribing quality. Future studies may focus on changing physicians’ prescribing behaviors in combination with multicomponent and multidisciplinary psychosocial alternatives. Trial registration Netherlands Trial Registry (NTR5872) on 27/05/2016, https://onderzoekmetmensen.nl/nl/node/26060/pdf . |
| format | Article |
| id | doaj-art-e5818e501790497c8abfe23d0ed51202 |
| institution | DOAJ |
| issn | 1471-2318 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Geriatrics |
| spelling | doaj-art-e5818e501790497c8abfe23d0ed512022025-08-20T03:06:04ZengBMCBMC Geriatrics1471-23182025-08-0125111410.1186/s12877-025-06206-yTailored interventions for inappropriate psychotropic drug use in nursing home residents with dementia: participatory action research in a special case of a stepped-wedge cluster randomized controlled trialClaudia M. Groot Kormelinck0Debby L. Gerritsen1Charlotte F. van Teunenbroek2Michiel R. de Boer3Martin Smalbrugge4Sytse U. Zuidema5Department of Primary and Long-term Care, University of Groningen, University Medical Centre GroningenDepartment of Primary and Community Care, Radboud UMC Alzheimer Centre, Research Institute for Medical Innovation, Radboud University Medical CentreDepartment of Primary and Long-term Care, University of Groningen, University Medical Centre GroningenDepartment of Primary and Long-term Care, University of Groningen, University Medical Centre GroningenDepartment of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit AmsterdamDepartment of Primary and Long-term Care, University of Groningen, University Medical Centre GroningenAbstract Background Psychotropic drugs are modestly effective and may cause adverse effects. Efforts to reduce inappropriateness and increase usage of psychosocial interventions often suffer from suboptimal implementation. The purpose of this study was to evaluate effectiveness of an innovative study using implementation promoting elements in nursing home residents with dementia and neuropsychiatric symptoms. Methods A multicenter cluster randomized controlled trial with a special case of a stepped-wedge design with two arms and one stap was designed. The intervention comprised participatory action research, tailored information provision and external coaching, leading to the implementation of tailored action and implementation plans. The primary outcome was inappropriateness of psychotropic drug use (Appropriate Psychotropic Drug Use in Dementia [APID] index) and the secondary outcome was percentage of psychotropic drug use at baseline, 8 months, and 16 months. Homes were allocated to start with usual care or the intervention. After 8 months, the control group crossed over to receive the intervention. The other homes continued the intervention to 16 months. Patients were eligible if they were diagnosed with dementia, had a life expectancy of at least 3 months, and resided in psychogeriatric units. Results An adjusted multilevel model revealed no effect on the APID index sum score at 8 months (0.564; 95% confidence interval [CI], -2.449–3.577; p = 0.71) or 16 months (2.165; 95% CI, -1.113–5.443; p = 0.20). An adjusted generalized estimation equation (GEE) model showed an effect at 16 months for percentage of use (OR 0.654; 95% CI, 0.481–0.889; p = 0.007). Adjusted GEE models showed an effect especially at 16 months for anxiolytics (OR 0.573; 95% CI, 0.382–0.859; p = 0.007) and antidepressants (OR 0.678; 95% CI, 0.475–0.968; p = 0.033). Conclusions No reduction of inappropriateness was found although overall usage was reduced. Professionals focused on implementing alternatives to compensate for usage, rather than prescribing quality. Future studies may focus on changing physicians’ prescribing behaviors in combination with multicomponent and multidisciplinary psychosocial alternatives. Trial registration Netherlands Trial Registry (NTR5872) on 27/05/2016, https://onderzoekmetmensen.nl/nl/node/26060/pdf .https://doi.org/10.1186/s12877-025-06206-yDementiaNursing homesPsychotropic drugsNeuropsychiatric symptomsComplex interventions |
| spellingShingle | Claudia M. Groot Kormelinck Debby L. Gerritsen Charlotte F. van Teunenbroek Michiel R. de Boer Martin Smalbrugge Sytse U. Zuidema Tailored interventions for inappropriate psychotropic drug use in nursing home residents with dementia: participatory action research in a special case of a stepped-wedge cluster randomized controlled trial BMC Geriatrics Dementia Nursing homes Psychotropic drugs Neuropsychiatric symptoms Complex interventions |
| title | Tailored interventions for inappropriate psychotropic drug use in nursing home residents with dementia: participatory action research in a special case of a stepped-wedge cluster randomized controlled trial |
| title_full | Tailored interventions for inappropriate psychotropic drug use in nursing home residents with dementia: participatory action research in a special case of a stepped-wedge cluster randomized controlled trial |
| title_fullStr | Tailored interventions for inappropriate psychotropic drug use in nursing home residents with dementia: participatory action research in a special case of a stepped-wedge cluster randomized controlled trial |
| title_full_unstemmed | Tailored interventions for inappropriate psychotropic drug use in nursing home residents with dementia: participatory action research in a special case of a stepped-wedge cluster randomized controlled trial |
| title_short | Tailored interventions for inappropriate psychotropic drug use in nursing home residents with dementia: participatory action research in a special case of a stepped-wedge cluster randomized controlled trial |
| title_sort | tailored interventions for inappropriate psychotropic drug use in nursing home residents with dementia participatory action research in a special case of a stepped wedge cluster randomized controlled trial |
| topic | Dementia Nursing homes Psychotropic drugs Neuropsychiatric symptoms Complex interventions |
| url | https://doi.org/10.1186/s12877-025-06206-y |
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