title: Interventions to reduce inappropriate prescribing of antipsychotic medications in people with dementia resident in care homes: a systematic review.
abstract: BACKGROUND
  Antipsychotic medications are commonly used to manage the behavioral and psychological symptoms of dementia. Several large studies have demonstrated an association between treatment with antipsychotics and increased morbidity and mortality in people with dementia.
  
  
  OBJECTIVE
  To assess the effectiveness of interventions used to reduce inappropriate prescribing of antipsychotics to the elderly with dementia in residential care.
  
  
  METHODS
  Systematic searches were conducted in 12 electronic databases. Reference lists of all included studies and forward citation searching using Web of Science were also conducted. All quantitative studies with a comparative research design and studies in which recognized methods of qualitative data collection were used were included. Articles were screened for inclusion independently by 2 reviewers. Data extraction and quality appraisal were performed by 1 reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary.
  
  
  RESULTS
  Twenty-two quantitative studies (reported in 23 articles) were included evaluating the effectiveness of educational programs (n = 11), in-reach services (n = 2), medication review (n = 4), and multicomponent interventions (n = 5). No qualitative studies meeting our inclusion criteria were identified. Eleven studies were randomized or controlled in design; the remainder were uncontrolled before and after studies. Beneficial effects were seen in 9 of the 11 studies with the most robust study design with reductions in antipsychotic prescribing levels of between 12% and 20%. Little empirical information was provided on the sustainability of interventions.
  
  
  CONCLUSIONS
  Interventions to reduce inappropriate prescribing of antipsychotic medications to people with dementia resident in care homes may be effective in the short term, but longer more robust studies are needed. For prescribing levels to be reduced in the long term, the culture and nature of care settings and the availability and feasibility of nondrug alternatives needs to be addressed.
authors.affiliation: NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK. Electronic address: j.thompson-coon@exeter.ac.uk.
authors.forename: Jo
authors.initials: J
authors.lastname: Thompson Coon
authors.affiliation: NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Abbott
authors.affiliation: NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Morwenna
authors.initials: M
authors.lastname: Rogers
authors.affiliation: NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Whear
authors.affiliation: Devon Partnership Trust, Ivybridge, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pearson
authors.affiliation: NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Lang
authors.affiliation: The Surgery, Ashburton, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Cartmell
authors.affiliation: NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Ken
authors.initials: K
authors.lastname: Stein
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy*; D006801:Humans; D057970:Inappropriate Prescribing; D009735:Nursing Homes
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic; care homes; dementia; prescribing behavior; systematic review