title: Neuroleptic and benzodiazepine use in long-term care in urban and rural Alberta: characteristics and results of an education intervention to ensure appropriate use.
abstract: OBJECTIVE
  To examine the use of psychotropic drugs in 24 rural and urban long-term care (LTC) facilities, and compare the effect of an education intervention for LTC staff and family members on the use of psychotropic drugs in intervention versus control facilities.
  
  
  METHODS
  Interrupted time series with a non-equivalent no-treatment control group time series. Data on drug use were collected in 24 Western Canadian LTC facilities (10 urban, 14 rural) for three 2-month time periods before and after the intervention. Pharmacy records were used to collect data on drug, class of drug, dose, administration, and start/stop dates. Chart reviews provided demographics, pro re nata (prn) use, and indications for drug use. Subjects comprised 2443 residents living in the 24 LTC facilities during the 1-year study. An average of 796.33 residents (32.7%) received a psychotropic drug. An education intervention on psychotropic drug use in LTC was offered to intervention physicians, nursing staff, pharmacists and family members.
  
  
  RESULTS
  Approximately one-third of residents received a psychotropic drug during the study, often for considerable lengths of time. A minority of psychotropic drug prescriptions had a documented reason for their use, and 69.5% of the reasons would be inappropriate under Omnibus Budget Reconciliation Act (OBRA) legislation. Few psychotropic drug prescriptions were discontinued or reduced during the study. More urban LTC residents received neuroleptics and benzodiazepines than their rural counterparts (26.1% vs. 15.7%, and 18.0% vs. 7.6%, respectively). The education intervention did not result in any significant decline in the use of these drugs in intervention facilities.
  
  
  CONCLUSIONS
  The results suggest substantial use of psychotropic drugs in LTC, although rural LTC residents received approximately half the number of psychotropic drugs compared with urban residents. A resource-intensive intervention did not significantly decrease the use of psychotropics. There is a need for better monitoring of psychotropic drugs in LTC, particularly given that voluntary educational efforts alone may be ineffective agents of change.
authors.affiliation: School of Health Sciences, The University of Lethbridge, Canada. brad.hagen@uleth.ca
authors.forename: Brad F
authors.initials: BF
authors.lastname: Hagen
authors.forename: Chris
authors.initials: C
authors.lastname: Armstrong-Esther
authors.forename: Paddy
authors.initials: P
authors.lastname: Quail
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Williams
authors.forename: Peter
authors.initials: P
authors.lastname: Norton
authors.forename: Carole-Lynn
authors.initials: CL
authors.lastname: Le Navenec
authors.forename: Roland
authors.initials: R
authors.lastname: Ikuta
authors.forename: Maureen
authors.initials: M
authors.lastname: Osis
authors.forename: Val
authors.initials: V
authors.lastname: Congdon
authors.forename: Roxane
authors.initials: R
authors.lastname: Zieb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D002391:Catchment Area, Health; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005192:Family Health; D005260:Female; D006266:Health Education; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D011595:Psychomotor Agitation / Q000188:drug therapy*; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology; D012424:Rural Population / Q000706:statistics & numerical data*; D013663:Teaching / Q000379:methods*; D014505:Urban Population / Q000706:statistics & numerical data*
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines