Getting many
residents off inappropriate antipsychotic prescriptions saved costs, while
sharply reducing falls and abusive behaviour.
A Canadian
health organization is launching a call to action for long-term care homes, to
change the culture of prescribing antipsychotics to residents who may not need
them in the first place.
The Canadian
Foundation for Healthcare Improvement hopes to shine a spotlight on
non-pharmacological therapies for residents with dementia, which in turn could
save money on prescriptions and hospital visits.
CFHI, a
non-profit organization that collaborates with governments and health-care
providers to improve the system, worked with 56 long-term care homes across the
country between 2014 and 2015, taking seniors off antipsychotics that had not been appropriately prescribed.
The Ottawa-based
organization released what it called “dramatic results” on Monday, including a
decrease in falls by 20 per cent, verbal abusive behaviour by 33 per cent and
physical abusive behaviour by 28 per cent, among the 416 residents involved.
Overall, CFHI
said antipsychotics were discontinued for 36 per cent of the residents, and
“significantly reduced” for 18 per cent.
“What we’re
really hoping for is to draw attention to the issue that we are inappropriately
prescribing these antipsychotic medications to people living with dementia in
long-term care,” Stephen Samis, CFHI vice-president for programs, told the
Star.
“There are
other, more effective ways of managing the so-called challenging behaviours
that are exhibited and that cause people to be put on these medications.”
While
acknowledging that some residents do need the medications, such as those with a
diagnosis for psychosis, Samis pointed out that long-term care homes are
inappropriately give them to individuals who have no such diagnosis as a short-term
fix for aggressive behaviour.
“I often say
that rarely do we put people in physical straitjackets, but these are really
chemical straitjackets, and when you begin to work with people, you're
releasing them and giving them the opportunity to be responsive again to the
world around them,” he said.
Samis suggested alternative therapies for
individuals, including gardening, music, and being with pets.
He said CFHI is
looking to collaborate with homes in every province to reduce antipsychotic
dependency. New Brunswick is already on board, he said, and CFHI will begin
working with more homes in that province this week.
Brand names for
the most common medications prescribed include Seroquel, Risperdal and Zyprexa.
The drugs are not approved by Health Canada for dementia, and come with strong
warnings from pharmaceutical companies.
But doctors are
legally allowed to prescribe them “off-label,” meaning they can be used for a
condition for which the drugs haven’t been approved.
A 2014 Star investigation found that Ontario
nursing homes, many suffering from staffing shortages, were drugging
seniors at an alarming rate, even though some
antipsychotic drugs can increase the risk for death in elderly people with
dementia.
At close to 300
homes, more than a third of the residents were on the drugs, the investigation
found.
CFHI estimates
that about 27 per cent of seniors in long-term care in Ontario are on
antipsychotics without a diagnosis for psychosis, a figure nearly identical to
the national average.
The organization
estimates that five years of antipsychotic reduction programs in Ontario would
cut 10 million drug prescriptions, save $13 million in antipsychotic
prescription costs, and save $90 million in health care costs related to falls.
“For a province
like Ontario, those are pretty significant savings,” Samis said.
David Juurlink,
a drug safety expert and head of clinical pharmacology and toxicology at
Sunnybrook Health Sciences Centre, said the CFHI numbers were “quite
impressive,” particularly relating to the decrease in falls, the main cause of
injury and hospitalization for seniors.
“The fact that
they were able to reduce antipsychotic prescribing as much as they did is a
testament to how overprescribed these drugs are in long-term care,” he said.
“They are an important element of care for some patients, but they come with a
host of side effects, some of them very serious. Often there are preferable
drug- and non-drug alternatives.
“I think if
those involved in the care of these patients, along with their families, asked
‘What exactly are we trying to accomplish with this drug?’ we'd see fewer
prescriptions, the healthcare system would save a small fortune, and patients
would be a lot better off.”
SOURCE: Jack
Gallant, The Star. Canada
No comments:
Post a Comment