PRESCRIBING IN NURSING HOMES MUST CROSS. HEALTHCARE SILOS. To the Editor: We read with interest the study by Zhang and colleagues,1 which ...
LETTER TO THE EDITOR
INTERVENTIONS TO REDUCE ANTIPSYCHOTIC PRESCRIBING IN NURSING HOMES MUST CROSS HEALTHCARE SILOS
To the Editor: We read with interest the study by Zhang and colleagues,1 which reported that, in more than onethird of residents prescribed antipsychotics in nursing homes (NHs), treatment was initiated in hospital and outpatient settings. We agree that interventions to reduce antipsychotic prescribing in the hospital and outpatient setting are important. However, constant vigilance and review of NH residents throughout their stays, including during transitions of care, is critical to ensuring quality use of medicines. Although evidence supports psychotropic use in NHs in some scenarios, we use them too often, for too long, at doses too high and in dangerous combinations with other medications.2,3 Resident and facility factors influence prescribing of antipsychotics in NHs.4 A contributing factor to antipsychotic prescribing is NH organizational culture. Our research has shown that staff perceptions of limited interdisciplinary teamwork and resources hindered review and cessation of antipsychotics.5 Organizational culture has a role in shaping on-site staff preference for antipsychotic medicines as a solution to time pressure and heavy workloads, and this feeds into what is suggested to general practitioners.6 For improvements to antipsychotic prescribing to be sustainable, a change in NH culture is required. In addition to addressing NH organizational culture, interventions need to be multifaceted and interdisciplinary and cross the care settings that the resident experiences. Poor communication and inadequate information during care transitions between hospitals and NHs can result in inappropriate psychotropic prescribing.7 Interventions to address prescribing of antipsychotics to NH residents in the hospital or outpatient setting require follow-up by a pharmacist or other healthcare professional, with the NH doctor and on-site nursing staff. Although understanding where antipsychotic medicines are initiated can help target initiation of interventions, these interventions must cross the silos of health care to provide person-centered care to vulnerable NH residents.
Mouna Sawan, PhD National Health and Medical Research Council Cognitive Decline Partnership Centre, Sydney University, Kolling Institute, St Leonards, New South Wales, Australia Timothy Chen, PhD Faculty of Pharmacy, Sydney University, Camperdown, New South Wales, Australia Yun-Hee Jeon, PhD Faculty of Nursing, Sydney University, Camperdown, New South Wales, Australia Sarah N. Hilmer, PhD National Health and Medical Research Council Cognitive Decline Partnership Centre, Sydney University, Kolling Institute, St Leonards, New South Wales, Australia
ACKNOWLEDGMENTS Conflicts of Interest: None of the authors have any conflicts of interest to disclose. Authors Contributions: MS and SH wrote the first draft letter. All authors participated in revisions. MS reviewed the final manuscript. Sponsor’s Role: None.
REFERENCES 1. Zhang Y, Letuchy EM, Carnahan RM. Where are antipsychotics prescribed in nursing homes initiated? J Am Geriatr Soc. 2018; doi: 10.1111/ JGS.15223 2. Hilmer SN, Gnjidic D. Rethinking psychotropics in nursing homes. Med J Aust 2013;198:77. 3. Simoni-Wastila L, Wei YJ, Luong M et al. Quality of psychopharmacological medication use in nursing home residents. Res Soc Admin Pharm 2014; 10:494–507. 4. Rochon PA, Stukel TA, Bronskill SE et al. Variation in nursing home antipsychotic prescribing rates. Arch Intern Med 2007;167:676–683. 5. Sawan M, Jeon YH, Fois RA, Chen TF. Exploring the link between organizational climate and the use of psychotropic medicines in nursing homes: A qualitative study. Res Soc Admin Pharm 2017;13:513–523. 6. Sawan M, Jeon Y-H, Chen TF. Shaping the use of psychotropic medicines in nursing homes: A qualitative study on organisational culture. Soc Sci Med. doi: 10.1016/j.socscimed.2018.02.010 7. Hughes CM, Lapane KL. Pharmacy interventions on prescribing in nursing homes: From evidence to practice. Ther Adv Drug Saf 2011;2:103–112.
See the Reply by Zhang et al.
DOI: 10.1111/jgs.15349
JAGS
2018
C 2018, Copyright the Authors V C 2018, The American Geriatrics Society Journal compilation V
0002-8614/18/$15.00
