iADAPT: Off-Label Use of Antipsychotics in the Nursing Home

Univ Of Massachusetts Med Sch Worcester, Worcester MA

Investigators

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Abstract

DESCRIPTION (provided by applicant): Off-Label Use of Atypical Antipsychotics in the Nursing Home We propose to adapt Comparative Effective Research (CER) Review products produced under AHRQ's Effective Health Care program, specifically related to off-label use of atypical antipsychotic drugs, to improve their penetration into practice in the nursing home setting. The prevalence of off-label use of atypical antipsychotic drugs among the 1.6 million residents of U.S. nursing homes is extraordinarily high;nationally, nearly 30% of all nursing home residents are prescribed antipsychotic medications, primarily atypical agents. The complexity of the nursing home setting presents special challenges for enhancing the use of CER Review products, such as the Comparative Effectiveness Research Summary Guide (CERSG) entitled "Off-Label Use of Atypical Antipsychotic Drugs." We propose a project with the following three aims: (Aim 1) to conduct a needs assessment for the nursing home setting relevant to the AHRQ CERSG entitled "Off-Label Use of Atypical Antipsychotic Drugs." The assessment will identify: (a) interest in and barriers to the use of the AHRQ atypical antipsychotic CERSG in the nursing home setting;(b) the key audiences and stakeholders that influence atypical antipsychotic drug use in nursing homes;and (c) approaches that could be used to integrate CER Review products into the nursing home setting. (Aim 2) Guided by the needs assessment, we will produce a toolkit containing tailored CERSG-based products targeting key audiences and stakeholders in the nursing home setting. The targets of the final CERSG-based products will be identified in Aim 1, and will potentially include: (a) facility leadership;(b) prescribers and consultant pharmacists;(c) nursing staff;and (d) residents and families. (Aim 3) To evaluate the effectiveness of the toolkit and three dissemination strategies using a matched, cluster randomized trial. Primary outcomes of the evaluation are the RE-AIM evaluation domains (reach, efficacy, adoption, implementation, and maintenance). We will also include an assessment of facility-level changes in the patterns of use of atypical antipsychotic drugs. PUBLIC HEALTH RELEVANCE: Off-Label Use of Atypical Antipsychotics in the Nursing Home Dementia is extraordinarily common in the nursing home setting affecting between 40% and 60% of all residents. The off-label use of atypical antipsychotics in the treatment of behavioral disturbances or agitation associated with dementia is widespread and increasing among nursing home residents in the United States despite mounting evidence of serious safety concerns and modest efficacy. The complexity of the nursing home setting presents special challenges for fostering use of the atypical antipsychotic Comparative Effectiveness Research Summary Guide.