Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial

Christin Richter; Almuth Berg; Henriette Langner; Gabriele Meyer; Sascha Köpke; Katrin Balzer; Eva-Maria Wolschon; Katharina Silies; Andreas Sönnichsen; Susanne Löscher; Burkhard Haastert; Andrea Icks; Ursula Wolf; Steffen Fleischer

doi:10.1093/ageing/afz016

Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial

Christin Richter, Almuth Berg, Henriette Langner, Gabriele Meyer, Sascha Köpke, Katrin Balzer, Eva-Maria Wolschon, Katharina Silies, Andreas Sönnichsen, Susanne Löscher, Burkhard Haastert, Andrea Icks, Ursula Wolf, Steffen Fleischer

Institute of Social Medicine and Epidemiology

Abstract

BACKGROUND: antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions.

OBJECTIVE: we investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions.

DESIGN: a 2-armed 12-month cluster-randomised controlled trial.

SETTING: nursing homes in East, North and West Germany.

METHODS: all prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation.

RESULTS: the study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9-21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038-2.532).

CONCLUSIONS: the implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02295462.

Original language	English
Journal	Age and ageing
Volume	48
Issue number	3
Pages (from-to)	419-425
Number of pages	7
ISSN	0002-0729
DOIs	https://doi.org/10.1093/ageing/afz016
Publication status	Published - 01.05.2019

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Richter, C., Berg, A., Langner, H., Meyer, G., Köpke, S., Balzer, K., Wolschon, E.-M., Silies, K., Sönnichsen, A., Löscher, S., Haastert, B., Icks, A., Wolf, U., & Fleischer, S. (2019). Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial. Age and ageing, 48(3), 419-425. https://doi.org/10.1093/ageing/afz016

@article{ce6e63cd036a4cd290c618816a42f2f7,

title = "Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial",

abstract = "BACKGROUND: antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions.OBJECTIVE: we investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions.DESIGN: a 2-armed 12-month cluster-randomised controlled trial.SETTING: nursing homes in East, North and West Germany.METHODS: all prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation.RESULTS: the study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9-21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038-2.532).CONCLUSIONS: the implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes.TRIAL REGISTRATION: ClinicalTrials.gov NCT02295462.",

author = "Christin Richter and Almuth Berg and Henriette Langner and Gabriele Meyer and Sascha K{\"o}pke and Katrin Balzer and Eva-Maria Wolschon and Katharina Silies and Andreas S{\"o}nnichsen and Susanne L{\"o}scher and Burkhard Haastert and Andrea Icks and Ursula Wolf and Steffen Fleischer",

note = "{\textcopyright} The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.",

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doi = "10.1093/ageing/afz016",

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Richter, C, Berg, A, Langner, H, Meyer, G, Köpke, S, Balzer, K, Wolschon, E-M, Silies, K, Sönnichsen, A, Löscher, S, Haastert, B, Icks, A, Wolf, U & Fleischer, S 2019, 'Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial', Age and ageing, vol. 48, no. 3, pp. 419-425. https://doi.org/10.1093/ageing/afz016

TY - JOUR

T1 - Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare)

T2 - a cluster-randomised controlled trial

AU - Richter, Christin

AU - Berg, Almuth

AU - Langner, Henriette

AU - Meyer, Gabriele

AU - Köpke, Sascha

AU - Balzer, Katrin

AU - Wolschon, Eva-Maria

AU - Silies, Katharina

AU - Sönnichsen, Andreas

AU - Löscher, Susanne

AU - Haastert, Burkhard

AU - Icks, Andrea

AU - Wolf, Ursula

AU - Fleischer, Steffen

PY - 2019/5/1

Y1 - 2019/5/1

N2 - BACKGROUND: antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions.OBJECTIVE: we investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions.DESIGN: a 2-armed 12-month cluster-randomised controlled trial.SETTING: nursing homes in East, North and West Germany.METHODS: all prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation.RESULTS: the study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9-21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038-2.532).CONCLUSIONS: the implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes.TRIAL REGISTRATION: ClinicalTrials.gov NCT02295462.

AB - BACKGROUND: antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions.OBJECTIVE: we investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions.DESIGN: a 2-armed 12-month cluster-randomised controlled trial.SETTING: nursing homes in East, North and West Germany.METHODS: all prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation.RESULTS: the study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9-21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038-2.532).CONCLUSIONS: the implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes.TRIAL REGISTRATION: ClinicalTrials.gov NCT02295462.

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UR - http://www.mendeley.com/research/effect-personcentred-care-antipsychotic-drug-nursing-homes-epcentcare-clusterrandomised-controlled-t-1

U2 - 10.1093/ageing/afz016

DO - 10.1093/ageing/afz016

M3 - Journal articles

C2 - 30806453

SN - 0002-0729

VL - 48

SP - 419

EP - 425

JO - Age and ageing

JF - Age and ageing

IS - 3

ER -

Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial

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