title: The use of a cholinesterase inhibitor review committee in long-term care.
abstract: OBJECTIVE
  The objective of the study was to document the effectiveness of a Cholinesterase Inhibitor (ChE-I) Review Committee in a long-term care (LTC) institution in Montreal, Canada.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Maimonides Geriatric Centre (MGC), a 387-bed LTC facility in Montreal, Canada, in which 352 patients have dementia.
  
  
  METHODS
  Fifty-two patients on ChE-I who were reviewed at least once by the ChE-I Review Committee between January and November 2005.
  
  
  METHODS
  Recommendations for discontinuation, actual discontinuation, and restarting of ChE-I, along with reasons underlying these decisions, were collected from the patients' charts over a 4-month period following Review Committee assessment.
  
  
  RESULTS
  The Review Committee recommended discontinuation of ChE-I in 17 (32.7%) of the 52 patients. After 1 patient died and therefore was excluded from the study, 13 (81.3%) of the remaining 16 were actually discontinued. The most common reasons for recommendation to discontinue ChE-I were insufficient benefit on cognition, activities of daily living (ADL), and behavior. Subsequently, ChE-I was resumed in 4 (30.8%) of the 13 patients discontinued, 2 because of ADL deterioration and 2 at the request of the family.
  
  
  CONCLUSIONS
  Through the review process, almost one third of ChE-I users were recommended for discontinuation because of insufficient benefit; the majority of these were discontinued. Fewer than one third were subsequently restarted. A ChE-I Review Committee seemed to be an effective and acceptable model for decision making regarding ChE-I use in LTC.
authors.affiliation: Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Canada. joy.lee.a@utoronto.ca <joy.lee.a@utoronto.ca>
authors.forename: Joyce
authors.initials: J
authors.lastname: Lee
authors.forename: Johanne
authors.initials: J
authors.lastname: Monette
authors.forename: Nadia
authors.initials: N
authors.lastname: Sourial
authors.forename: Michele
authors.initials: M
authors.lastname: Monette
authors.forename: Howard
authors.initials: H
authors.lastname: Bergman
mesh_terms: D026683:Advisory Committees; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D003657:Decision Making; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009735:Nursing Homes; D018579:Patient Selection; D010865:Pilot Projects; D011792:Quebec
chemical_list: D002800:Cholinesterase Inhibitors