title: The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD).
abstract: BACKGROUND
  Behavioral and psychological symptoms of dementia (BPSD) are virtually ubiquitous in dementia. Excessive recourse to use of psychotropics which have high risk to benefit ratio remains a global problem. We aimed to identify components of quality prescribing in BPSD to develop a tool for quality prescribing and to test this tool.
  
  
  METHODS
  We used Delphi methodology to identify elements of quality prescribing in BPSD. The tool was tested by a range of medical and nursing professionals on 48 patients, in inpatient and ambulatory settings in Northern Sydney Local Health District, Australia.
  
  
  RESULTS
  Consensual opinion using Delphi method was that quality prescribing in dementia comprised ten factors including failure to use first line non-pharmacological strategies, indication, choice of drug, consent, dosage, mode of administration, titration, polypharmacy, toxicity, and review. These elements formed the quality use of medications in dementia (QUM-D) tool, lower scores of which reflected quality prescribing, with a possible range of scores from 0 to 30. When inter-rater reliability was tested on a subgroup of raters, QUM-D showed high inter-rater reliability. A significant reduction in QUM-D scores was demonstrated from baseline to follow-up, mean difference being 5.3 (SD = 3.8; 95% confidence interval 4.1-6.4; t = 9.5; df = 47; p < 0.001). There was also a significant reduction in score from baseline to follow-up when rated by clinical nurse consultants from a specialized behavior assessment management service (BAMS) (N = 12).
  
  
  CONCLUSIONS
  The QUM-D is a tool which may help to improve quality prescribing practices in the context of BPSD. In this setting, we consider quality prescribing, and accordingly the obligations of prescribers, to be an inclusive concept rather than just adding to the mantra of "not prescribing."
authors: Specialist Mental Health Services for Older People,Mental Health Drug and Alcohol,Northern Sydney Local Health District,Sydney,Australia.
authors: Carmelle
authors: C
authors: Peisah
authors: Specialist Mental Health Services for Older People,Mental Health Drug and Alcohol,Northern Sydney Local Health District,Sydney,Australia.
authors: Julie-Anne
authors: JA
authors: Strukovski
authors: University of NSW,Sydney,Australia.
authors: Chanaka
authors: C
authors: Wijeratne
authors: Specialist Mental Health Services for Older People,Mental Health Drug and Alcohol,Northern Sydney Local Health District,Sydney,Australia.
authors: Rosalind
authors: R
authors: Mulholland
authors: University of Sydney,Sydney,Australia.
authors: Georgina
authors: G
authors: Luscombe
authors: Dementia Collaborative Research Centre,University of New South Wales,Sydney,Australia.
authors: Henry
authors: H
authors: Brodaty
mesh_terms: D003661:Decision Support Techniques; D003697:Delphi Technique; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011307:Drug Prescriptions / Q000592:standards; D006801:Humans; D018697:Nootropic Agents / Q000627:therapeutic use*; D015588:Observer Variation; D011787:Quality of Health Care / Q000592:standards; D016896:Treatment Outcome
chemical_list: D018697:Nootropic Agents
keywords: BPSD; dementia; medications; prescribing; quality
references: Am J Psychiatry. 2012 Sep;169(9):946-53
references: 22952073
references: Br J Psychiatry. 2014 Jul;205(1):4-5
references: 24986385
references: N Engl J Med. 2012 Oct 18;367(16):1497-507
references: 23075176
references: Br J Psychiatry. 2012 Sep;201(3):221-6
references: 22790679
references: J Am Med Dir Assoc. 2014 Oct;15(10):706-18
references: 25112229
references: Am J Geriatr Psychiatry. 2004 Sep-Oct;12(5):499-508
references: 15353388
references: Am J Geriatr Psychiatry. 2006 Mar;14(3):191-210
references: 16505124
references: J Am Geriatr Soc. 2010 Jun;58(6):1027-34
references: 20487081
references: BMC Psychiatry. 2013 Nov 01;13:280
references: 24180295
references: Arch Intern Med. 2003 Dec 8-22;163(22):2716-24
references: 14662625
references: J Am Geriatr Soc. 2005 Aug;53(8):1290-5
references: 16078953
references: Int Psychogeriatr. 2014 Jul;26(7):1083-98
references: 24565226
references: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD003945
references: 19588348
references: J Clin Psychiatry. 2003 Feb;64(2):134-43
references: 12633121
references: Int J Geriatr Psychiatry. 2001 May;16(5):504-12
references: 11376467
references: Am J Psychiatry. 2012 Jan;169(1):71-9
references: 22193526
references: Lancet Neurol. 2009 Apr;8(4):317-25
references: 19282246
references: Lancet Neurol. 2009 Feb;8(2):151-7
references: 19138567
references: Nurs Res. 2006 Jul-Aug;55(4):252-8
references: 16849977
references: Int J Geriatr Psychiatry. 2007 Sep;22(9):843-9
references: 17193341
references: Drugs Today (Barc). 2003 Jul;39(7):551-7
references: 12973403
references: PLoS Med. 2008 Apr 1;5(4):e76
references: 18384230
references: Arch Intern Med. 2007 Apr 9;167(7):676-83
references: 17420426
references: Br J Psychiatry. 2014 Jul;205(1):44-51
references: 23929443
references: Cochrane Database Syst Rev. 2013 Mar 28;(3):CD007726
references: 23543555
references: Arch Intern Med. 2007 Apr 23;167(8):781-7
references: 17452540
references: Am Fam Physician. 2007 Dec 15;76(12):1837-44
references: 18217523
references: Res Nurs Health. 2008 Feb;31(1):42-51
references: 18163447
references: J Am Geriatr Soc. 2014 Apr;62(4):762-9
references: 24635665
references: Expert Opin Drug Saf. 2011 Jan;10(1):35-43
references: 20684745
references: Arch Intern Med. 2011 Jun 13;171(11):1013-9
references: 21670370
references: J Am Geriatr Soc. 2012 Apr;60(4):616-31
references: 22376048
references: Int Psychogeriatr. 2009 Apr;21(2):241-51
references: 19138459
references: BMJ. 2012 Feb 23;344:e977
references: 22362541
references: Int Psychogeriatr. 2014 Jul;26(7):1147-60
references: 24666667
references: Lancet. 2011 Jul 30;378(9789):403-11
references: 21764118
references: Med J Aust. 2011 Mar 7;194(5):270-1
references: 21382008
references: J Am Geriatr Soc. 1990 Jan;38(1):37-44
references: 1967262
references: Am J Geriatr Psychiatry. 2010 Apr;18(4):332-40
references: 20220589
references: Int J Geriatr Psychiatry. 2009 Mar;24(3):226-31
references: 18666309
references: CNS Drugs. 2010 Sep;24(9):729-39
references: 20806986
references: Am J Psychiatry. 2005 Nov;162(11):1996-2021
references: 16263837
references: Cochrane Database Syst Rev. 2016 Feb 12;2:CD009095
references: 26866421
references: Psychometrika. 2009 Mar;74(1):107-120
references: 20037639
references: J Adv Nurs. 2007 Jun;58(6):532-40
references: 17542803
references: Arch Intern Med. 1997 Jul 28;157(14):1531-6
references: 9236554
references: Nat Rev Neurol. 2009 May;5(5):245-55
references: 19488082
references: Drugs Aging. 2001;18(1):45-61
references: 11232738