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Dissemination of Evidence‐Based Antipsychotic Prescribing Guidelines to Nursing Homes: A Cluster Randomized Trial
Author(s) -
Tjia Jennifer,
Field Terry,
Mazor Kathleen,
Lemay Celeste A.,
Kanaan Abir O.,
Donovan Jennifer L.,
Briesacher Becky A.,
Peterson Daniel,
Pandolfi Michelle,
Spenard Ann,
Gurwitz Jerry H.
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13488
Subject(s) - medicine , audit , randomized controlled trial , antipsychotic , dissemination , cluster randomised controlled trial , academic detailing , cluster (spacecraft) , evidence based practice , nursing , intervention (counseling) , family medicine , psychiatry , schizophrenia (object oriented programming) , alternative medicine , telecommunications , management , computer science , economics , programming language , pathology
Objectives To evaluate the effectiveness of efforts to translate and disseminate evidence‐based guidelines about atypical antipsychotic use to nursing homes ( NH s). Design Three‐arm, cluster randomized trial. Setting NH s. Participants NHs in the state of Connecticut. Measurements Evidence‐based guidelines for atypical antipsychotic prescribing were translated into a toolkit targeting NH stakeholders, and 42 NH s were recruited and randomized to one of three toolkit dissemination strategies: mailed toolkit delivery (minimal intensity); mailed toolkit delivery with quarterly audit and feedback reports about facility‐level antipsychotic prescribing (moderate intensity); and in‐person toolkit delivery with academic detailing, on‐site behavioral management training, and quarterly audit and feedback reports (high intensity). Outcomes were evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance ( RE ‐ AIM ) framework. Results Toolkit awareness of 30% (7/23) of leadership of low‐intensity NH s, 54% (19/35) of moderate‐intensity NH s, and 82% (18/22) of high‐intensity NH s reflected adoption and implementation of the intervention. Highest levels of use and knowledge among direct care staff were reported in high‐intensity NH s. Antipsychotic prescribing levels declined during the study period, but there were no statistically significant differences between study arms or from secular trends. Conclusion RE ‐ AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends. Further dissemination to external stakeholders such as psychiatry consultants and hospitals may be needed to influence antipsychotic prescribing for NH residents.