Role of antipsychotics for treating behavioral and psychological symptoms of dementia

Table 1 Selected original intervention studies aimed to improve antipsychotic use in the nursing home

Intervention type	Study design	Study duration	Healthcare disciplines providing intervention	Changes in antipsychotic use
Audit-feedback
Castle[120]	CT	1 yr	NA	4.8% reduction in intervention group; SS
Westbury et al[119]	CT	26 wk	P, Ph, N	1.7% reduction in intervention group; SS
Watson-Wolfe et al[122]	SSBAS	2 mo	N	4.9% reduction
Education
Hagen et al[126]	CT	1 yr	Ph	Increases in antipsychotic use; no SS in intervention group but SS in control group
Testad et al[125]	CRCT	1 yr	P	Increases in antipsychotic use; no SS
Monette et al[127]	SSBAS	7 mo	P, Psy, Ph, N	49% discontinued antipsychotics, 13.6% had dose reduction
Medication review
Patterson et al[129]	CRCT	1 yr	P, Ph, N	9.4% reduction in intervention group; odds ratio of antipsychotic use for intervention group vs control = 0.26 (95%CI: 0.14–0.49); SS
Chakraborty et al[131]	MSBAS	2 yr	Psy, N	13.4% reduction
Case conferencing
Dahl et al[133]	SSBAS	1 yr	P, Ph, N	1.3% reduction
Structured monitoring
Yap et al[104]	SSBAS	24 wk	P, Ph, N	4 times increase in antipsychotic prescribing decisions due to side-effects reported; SS
Psychosocial intervention
Fossey et al[134]	CRCT	10 mo	Psychologist, occupational therapist, N	19.1% reduction in intervention group; lower prevalence in intervention group (19.1% vs 42.1%); SS
Bird et al[135]	CT	9 mo	P, Psy, N, Psychologist	15.7% reduction in intervention group; SS

CRCT: Cluster-randomized controlled trial; CT: Controlled trial (non-randomized); MSBAS: Multi-site, before-and-after study; N: Nurse; NA: Not assessed; P: Physician; Ph: Pharmacist; Psy: Psychiatrist; SSBAS: Single site, before-and-after study; SS: Statistically significant.