Evaluating a training program for rural doctors and nursing home staff on safe medicine use for patients with dementia and nursing home residents / Ryan Carnahan.

Format:

Book

Author/Creator:

Carnahan, Ryan, author.

Language:

English

Subjects (All):

Dementia--Patients--Care.

Dementia.

Dementia--Patients--Family relationships.

Physical Description:

1 online resource

Place of Publication:

Washington, DC : Patient-Centered Outcomes Research Institute (PCORI), 2020.

Summary:

BACKGROUND: Antipsychotics are commonly prescribed for behavioral and psychological symptoms of dementia (BPSD), despite adverse effects. We developed the Improving Antipsychotic Appropriateness in Dementia Patients (IA-ADAPT) educational program to improve care for BPSD, reduce unnecessary antipsychotic use, and target overuse of anticholinergics and benzodiazepines, which adversely affect cognition. IA-ADAPT includes lectures, decision aids, and evidence reviews. Beginning in April 2012, we disseminated IA-ADAPT through a website and presentations. A short-term evaluation in Iowa nursing home residents suggested benefits, so we proposed a distance learning intervention to increase the impact in rural areas. Because of the large population of professional caregivers from Spanish-speaking countries in the United States, we believed that a Spanish translation of IA-ADAPT might be useful. OBJECTIVES: This project had 3 aims: (1) evaluate the long-term effects of IA-ADAPT; (2) test a distance learning intervention targeting providers in rural counties with decision aids and offers of academic detailing and consultation by videoconference or phone; and (3) create a Spanish version of the online IA-ADAPT program and disseminate it in Texas. METHODS: Aim 1: The long-term evaluation of IA-ADAPT used Medicare and nursing home assessment data from April 2011 through December 2014, linked with provider exposure data. We examined effects in 2 groups: (1) nursing home residents and (2) outpatients with dementia. Primary outcomes were antipsychotic and anticholinergic use. Secondary outcomes included benzodiazepine use and BPSD. We examined IA-ADAPT effects in the first year after provider exposure and subsequently. Analyses used mixed models and an interrupted time-series design using patients of providers not yet exposed as controls. Aim 2: We offered the distance learning intervention in 2 phases, targeting providers in rural Iowa counties with ≥ 10% of residents aged 75 years or older. Starting in October 2013, the staff of Iowa State Extension and Outreach delivered recruitment and resource packets to prescribers and nursing homes in 10 counties that we chose based on staff availability. Specialists provided academic detailing and consultation to willing providers. In July 2014, we mailed packets to providers in 19 additional randomly selected counties to increase recruitment. Ten eligible unexposed counties comprised the comparison group. Outcomes mirrored those for aim 1. Aim 3: We created a Spanish version of IA-ADAPT and disseminated it via our website. Spanish-speaking dementia care providers helped refine decision aid translations. We mailed advertisements to all nursing homes in Texas. RESULTS: All odds ratios (ORs) represent changes in the odds of each outcome per month after intervention exposure. Aim 1: In the first year, nursing home staff exposure to IA-ADAPT was associated with reduced antipsychotic (OR 0.966 [95% CI, 0.960-0.973]) and anticholinergic (OR 0.983 [95% CI, 0.977-0.989]) use but with increased benzodiazepine use subsequently (OR 1.014 [95% CI, 1.006-1.022]). The effects on BPSD varied over time. In outpatients, prescriber exposure to IA-ADAPT was associated with increased odds of antipsychotic (OR 1.046 [95% CI, 1.019-1.075]) and anticholinergic (OR 1.039 [95% CI, 1.021-1.057]) use in the first year, followed by decreased use subsequently (OR 0.947 [95% CI, 0.920-0.976] and OR 0.978 [95% CI, 0.960-0.996], respectively). Aim 2: Among nursing home residents, the distance learning intervention was not associated with different trends in antipsychotic (OR 0.984 [95% CI, 0.963-1.005]), anticholinergic (OR 0.990 [95% CI, 0.975-1.005]), or benzodiazepine (OR 0.979 [95% CI, 0.956-1.002]) use compared with controls. Secondary analyses suggested both desirable and undesirable effects. We observed no distance learning intervention effects in outpatients. Aim 3: Uptake of the Spanish version of IA-ADAPT was limited. CONCLUSIONS: IA-ADAPT and the distance learning program were associated with both desirable and undesirable effects. Most IA-ADAPT effects occurred in the first year after exposure. We do not recommend the distance learning intervention as delivered. The Spanish version of IA-ADAPT received little use. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: Intervention effects were small and sensitive to modeling strategies.

Contents:

Memory and dementia

Types of dementia

Diagnosis

Early-stage dementia

Moderate dementia

Severe dementia

Therapies for dementia

Medical treatments for dementia

Behavioural and psychological difficulties

Caregiving

Looking after someone at home

Choosing residential care

In residential care

End-of-life issues

Groups with special needs

Spiritual and cultural issues

Legal and ethical issues. "This comprehensive book has been written to give people the information they need to understand and come to terms with this illness, and cope with the changes that occur as the disease takes its course. It explains what dementia is, the different forms it takes, how and where to get help, diagnostic tests, treatment and medication, and the services available. It examines the issues involved in both caring for a sufferer at home, and when the time comes to choose residential care. It is difficult for carers to achieve the right balance of reality and hope. Dementia can be a grim condition, which progressively deprives people of the attributes they value. But in this book, old-age psychiatry specialist Dr. Chris Perkins aims to help caregivers at all levels deal with it with acceptance and compassion, offering humane and respectful care to people with dementia"

Publisher's information.-Includes index.

Notes:

Description based on publisher supplied metadata and other sources.