Antipsychotic prescribing in care homes before and after launch of a national dementia strategy: an observational study in English institutions over a 4-year period
Open accessAbstract
OBJECTIVES: To assess associations between the launch of the National Dementia Strategy (NDS) and antipsychotic prescribing in long-term residential care (LTC) in England. SETTING AND PARTICIPANTS: Retrospective analysis of prescribing patterns in 616 LTC institutions (31 619 residents) following launch of the NDS, using information from electronic medicines management system. PRIMARY AND SECONDARY OUTCOME MEASURES: Antipsychotic prescribing point prevalence (PP) for all residents in a cross section of LTC settings over a 4-year period following NDS launch. Secondary outcomes included dosages, length of treatment and use of recommended second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs). Associations between facility-level PP values and institutional characteristics, resident demographics were explored. Variations across geographical areas examined. Prescription net ingredient costs calculated. RESULTS: No statistically significant difference was observed in overall prescribing rates over the 4-year period (Kolmogorov-Smirnov (KS) test p=0.60), and there was no significant shift towards newer SGAs (KS test p=0.32). Dosages were above the maximum indicated in only 1.3% of cases, but duration of prescribing was excessive in 69.7% of cases. Care homes in the highest prescribing quintile were more likely to be located in a deprived area (rate ratio (Q5/Q1) RR=5.89, 95% CI 4.35 to 7.99), registered for dementia (RR=3.38, 95% CI 3.06 to 3.73) and those in the lowest quintile were more likely to be served by a single general practitioner (GP) practice (RR=0.48; 95% CI 0.37 to 0.63); p<0.001 all. A sixfold variation in PP levels was observed between geographical areas. The average annual expenditure on antipsychotics was £65.6 per person resident (2012 prices). CONCLUSIONS: The NDS in England was not associated with reduced PP levels or the types of antipsychotic prescribing in care homes. Further research is needed to explore why. Clear standards specifying recommended agents, dosages and length of treatment, together with routine monitoring and greater accountability for antipsychotic prescribing, may be required.
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Despite national policies such as the UK National Dementia Strategy having some effect on antipsychotic prescribing, prescribing of other psychotropics is still relatively common in dementia and other older people.
“Despite national policies such as the UK National Dementia Strategy having some effect on antipsychotic prescribing, prescribing of other psychotropics is still relatively common in dementia and other older people [39, 40].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [39]
The Discussion reports that reductions in antipsychotic prescribing associated with the National Dementia Strategy were not sustained in care homes, supporting the claim that the policy had some effect. The paper examines antipsychotics, however, and does not establish that prescribing of other psychotropics remains common among people with dementia or older people more broadly (searched: other psychotropic medications, psychotropics). (LLM, conf=0.88)
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“Despite national policies such as the UK National Dementia Strategy having some effect on antipsychotic prescribing, prescribing of other psychotropics is still relatively common in dementia and other older people [39, 40].”
Background
- Authors
- Szczepura, A., Wild, D., Khan, A. J., Owen, D. W., Palmer, T., Muhammad, T., Clark, M. D., & Bowman, C.
- Affiliations
- Coventry University (GB)
- University of Warwick (GB)
- Lancaster University (GB)
- Invatech Health Ltd, Bristol, UK
- University of East Anglia (GB)
- City, University of London (GB)
- Corresponding author
- Szczepura, Ala
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2016-09
- Volume
- 6
- Issue
- 9
- Pages
- e009882
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5051335
- OpenAlex
- W2464850479
- Cited by
- 44
- References
- 59
- Citations by year
- 2025: 2 · 2024: 5 · 2023: 2 · 2022: 1 · 2021: 6 · 2020: 6 · 2019: 6 · 2018: 9 · 2017: 6 · 2016: 1
- FWCI
- 4.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, other-oa)
- Lancaster EPrints (Lancaster University) (acceptedVersion, cc-by-nc)
- UEA Digital Repository (University of East Anglia) (acceptedVersion, cc-by-nc)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion, cc-by-nc)
- Coventry University Open Collections (Coventry university) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Pure (Coventry University) (submittedVersion, cc-by-nc)
- The Open Collections (Coventry University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- care homes, long-term residential care, National Dementia Strategy, dementia, atypical antipsychotics, typical antipsychotics, inappropriate prescribing, prescribing variation, deprivation, England
- MeSH terms
- Aged, 80 and over, Dementia, Drug Utilization, England, Female, Humans, Long-Term Care, Male, Nursing Homes, Practice Patterns, Physicians', Retrospective Studies, Time Factors, Antipsychotic Agents
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