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Effect of Person-Centred Care on antipsychotic drug use in nursing homes: a cluster randomised controlled trial

Short Title

  •  EPCentCare

Period

  • 03/2014 - 08/2017

Project Leader

  • Prof. Dr. phil. Gabriele Meyer (Halle)
  • Prof. Dr. phil. Sascha Köpke (Lübeck)
  • Prof. Dr. med. Andreas Sönnichsen (Witten)

Staff members

  • Dr. Almuth Berg
  • Dr. Steffen Fleischer
  • Christin Richter, M.Sc GPW
  • Dr. med. Ursula Wolf
  • Henriette Langner, B.A.

Associate Partners

  • Institute of Social Medicine and Epidemiology, University of Lübeck, Germany
  • Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Germany

Support

  • German Federal Ministry of Education and Research (BMBF grant: 01GY1335A)

Abstract  

Background

The majority of nursing home residents with dementia experience behavioural and psychological symptoms of dementia (BPSD) like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany and other European countries, antipsychotics are prescribed in up to 30% of nursing home residents. Antipsychotic drugs seem to be prescribed as first line treatment for BPSD. A huge number is prescribed for inappropriate reasons and for a too long period without carrying out regular review. All antipsychotics are associated with an increased risk of stroke. Adverse effects also include sedation, dizziness and increased risk of falling. A Cochrane review indicates that training and support for care home staff reduces antipsychotics in residents with dementia.

Aim

This study aims to investigate whether a recently in the United Kingdom successfully proven person-centred care approach in nursing home residents (Fossey et al., 2006) can be implemented in German nursing homes and results in a clinically relevant reduction of the number of residents taking antipsychotic drugs compared to a control group. 

Methods

The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial skill training on person-centred care and on-going training and support programme) with a control group receiving optimized usual care. Both study groups will receive a medication review by an experienced psychiatrist with feedback to the prescribing physician. Overall, 36 nursing homes from East, North and West Germany will be included and randomised in one of both groups. 
 The primary endpoint will be the proportion of residents receiving at least one antipsychotic prescription at 12 months. Secondary outcomes are residents’ quality of life, behavioural and psychological symptoms of dementia (BPSD) as well as safety parameters like falls and fall-related medical attention. Cost parameters will be collected and process evaluation will be performed.

Trial Registration

ClinicalTrials.gov Identifier: NCT02295462

Keywords

  • implementation research 
  • nursing homes
  • antipsychotic medication
  • dementia