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A pharmacy led program to review anti-psychotic prescribing for people with dementia.

Child A, Clarke A, Fox C, Maidment I - BMC Psychiatry (2012)

Bottom Line: Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review.Anti-psychotics were used more commonly within care home settings.The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Avante Care and Support, De Gesley House, 1 Jubilee Way, Faversham, Kent ME13 8GD, UK.

ABSTRACT

Background: Anti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics.

Methods: This project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search.

Results: Data were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (pā€‰<ā€‰0.0001; Fisher's exact test). In 26 practices there was no-one on the dementia register receiving low-dose anti-psychotics.Of the 161 people with dementia prescribed low-dose anti-psychotics, 91 were receiving on-going treatment from local secondary care mental health services or Learning Disability Teams. Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review.

Conclusions: In total 15.3% of people on the dementia register were receiving a low-dose anti-psychotic. However, such data, including the recent national audit may under-estimate the usage of anti-psychotics in people with dementia. Anti-psychotics were used more commonly within care home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.

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Related in: MedlinePlus

Intervention Flow chart.
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Figure 1: Intervention Flow chart.

Mentions: See Figure 1 for a diagrammatical representation of the results.


A pharmacy led program to review anti-psychotic prescribing for people with dementia.

Child A, Clarke A, Fox C, Maidment I - BMC Psychiatry (2012)

Intervention Flow chart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472196&req=5

Figure 1: Intervention Flow chart.
Mentions: See Figure 1 for a diagrammatical representation of the results.

Bottom Line: Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review.Anti-psychotics were used more commonly within care home settings.The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Avante Care and Support, De Gesley House, 1 Jubilee Way, Faversham, Kent ME13 8GD, UK.

ABSTRACT

Background: Anti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics.

Methods: This project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search.

Results: Data were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (pā€‰<ā€‰0.0001; Fisher's exact test). In 26 practices there was no-one on the dementia register receiving low-dose anti-psychotics.Of the 161 people with dementia prescribed low-dose anti-psychotics, 91 were receiving on-going treatment from local secondary care mental health services or Learning Disability Teams. Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review.

Conclusions: In total 15.3% of people on the dementia register were receiving a low-dose anti-psychotic. However, such data, including the recent national audit may under-estimate the usage of anti-psychotics in people with dementia. Anti-psychotics were used more commonly within care home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.

Show MeSH
Related in: MedlinePlus