Frontline staff effective in reducing antipsychotic use: study

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“The same issues for the off-label use of antipsychotics that are of concern in nursing homes are the same as those in assisted living communities,” said Jennifer Tjia, M.D., MSCE.
“The same issues for the off-label use of antipsychotics that are of concern in nursing homes are the same as those in assisted living communities,” said Jennifer Tjia, M.D., MSCE.

The off-label use of antipsychotic medication to treat cognitively impaired residents can be significantly reduced by training frontline staff members to recognize that individuals may exhibit challenging behaviors when trying to communicate about their unmet needs, according to the results of a study published Monday in JAMA Internal Medicine.

The conclusion was based on a study of a curriculum and training program in nursing homes that was conducted by Jennifer Tjia, M.D., MSCE, associate professor of quantitative health sciences at the University of Massachusetts Medical School, and colleagues. Tjia told McKnight's Senior Living, however, that the findings also are applicable wherever those with dementia receive care, such as assisted living and memory care communities.

“The same issues for the off-label use of antipsychotics that are of concern in nursing homes are the same as those in assisted living communities,” Tjia said. “Understanding challenging behaviors as the communication of unmet needs can help reduce unnecessary antipsychotic use for this vulnerable population.”

In reportedly the largest study of its kind, the researchers studied the rate of off-label antipsychotic use in 93 Massachusetts nursing homes enrolled in the OASIS program from 2011 to 2013 and compared it with the rate in 831 nursing homes in Massachusetts and New York that were not using the program (although some were using a different antipsychotic reduction program).

The OASIS intervention, developed by the Massachusetts Senior Care Association and the Massachusetts Department of Health, teaches nursing assistants, nurses, dietary staff, receptionists and other frontline staff how to meet the needs of residents with dementia using nonpharmacologic approaches rather than medication.

Facilities in the study using the OASIS program saw the prevalence of antipsychotic use drop 7%, from 34 to 27%, after nine months, the researchers found, whereas the other facilities saw a 4% decrease, from 23 to 19%. No increases in other psychotropic medicine or behavioral disturbances were observed.

“The OASIS program asks nursing staff to create care plans that include what residents can do, shifting away from the model that focuses on what they can't do,” Tjia said. “This is a fundamental shift in how to think about caring for persons with dementia, and we showed that it is effective.”

The authors said they found the program's effectiveness especially noteworthy because it mainly involved frontline staff rather than prescribers.

The decreases in medication use did not continue over time, however. Facilities using the OASIS program, Tjia said, should reinforce the training periodically to sustain the cuts.

The reduction of the off-label use of antipsychotics in assisted living has been a priority for AMDA–The Society for Post-Acute and Long-Term Care Medicine, the National Center for Assisted Living and LeadingAge as well as other industry groups. A 2015 report by the Government Accountability Office called for greater scrutiny of the drugs' use to treat individuals with dementia living in assisted living communities.

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