title: A Multicomponent Intervention to Optimize Psychotropic Drug Prescription in Elderly Nursing Home Residents: An Italian Multicenter, Prospective, Pilot Study.
abstract: BACKGROUND
  Older nursing home residents often have a large number of diseases and frequently require multiple medications; the high consumption of psychotropic drugs is of particular concern. The majority of residents in nursing homes suffer from dementia, and the use of psychotropic drugs in these patients is very high. Prescription for short periods of time only are usually recommended to avoid the risk of adverse drug reactions and potentially severe drug-drug interactions (DDIs).
  
  
  OBJECTIVE
  The aim of this multicenter, prospective study was to optimize the prescription of psychotropic drugs, according to the Beers recommendations, in a sample of older patients living in nursing homes in Italy, through a multicomponent intervention, education of general practitioners, and the use of INTERcheck.
  
  
  METHODS
  The study was run in ten nursing homes in Northern Italy from September 2013 to May 2014 (9 months), with the voluntary participation of 14 general practitioners. Each physician was asked to enroll at least 20 consecutive unselected patients. Three educational interventions ('ex cathedra' presentations) were organized by the researchers involved in the project, and a fourth training session was also held on the use of INTERCheck, a Computerized Prescription Support System (CPSS) developed to optimize drug prescription for older people with multimorbidity. Drug prescription information and sociodemographic characteristics of each patient were collected at three different time points-before the educational and training sessions (T0), after 5 months (T1), and after 9 months (T2).
  
  
  RESULTS
  Among the 272 patients included in the analysis, a significant reduction was observed in the mean number of drugs, and in the percentage receiving psychotropic drugs and potentially inappropriate psychotropic drugs (11.5 and 30.6 %, respectively; p < 0.0001). Patients exposed to at least one potentially severe DDI also decreased from 145 (53.3 %) at the first time point to 87 (32.0 %) at the last time point (p < 0.0001). Results were confirmed in the 181 patients for whom information regarding drug treatment was available at all time points.
  
  
  CONCLUSIONS
  The combination of an educational intervention and the CPSS can achieve a significant reduction in potentially inappropriate psychotropic drug use, psychotropic duplicates, and potentially severe DDIs in nursing homes.
authors.affiliation: Pharmacotherapy and Appropriateness of Drugs Prescription Unit, IRCCS-Istituto di Ricerche farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy. luca.pasina@marionegri.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.affiliation: Geriatric Unit, Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
authors.affiliation: Geriatric Unit, Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Ghibelli
authors.affiliation: Pharmacotherapy and Appropriateness of Drugs Prescription Unit, IRCCS-Istituto di Ricerche farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Suardi
authors.affiliation: Pharmacotherapy and Appropriateness of Drugs Prescription Unit, IRCCS-Istituto di Ricerche farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy.
authors.forename: Codjo D
authors.initials: CD
authors.lastname: Djade
authors.affiliation: Pharmacotherapy and Appropriateness of Drugs Prescription Unit, IRCCS-Istituto di Ricerche farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
authors.affiliation: Pharmacotherapy and Appropriateness of Drugs Prescription Unit, IRCCS-Istituto di Ricerche farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156, Milan, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Franchi
authors.affiliation: Brescia Solidale Foundation Nursing Homes, Brescia, Italy.
authors.forename: Gianbattista
authors.initials: G
authors.lastname: Guerrini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000188:drug therapy / Q000453:epidemiology; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000517:prevention & control; D017598:Efficiency, Organizational; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects / Q000517:prevention & control / Q000706:statistics & numerical data; D007318:Inservice Training / Q000379:methods / Q000458:organization & administration; D007558:Italy / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D018570:Risk Assessment; D012308:Risk Management / Q000379:methods
chemical_list: D011619:Psychotropic Drugs