Halting Antipsychotic Use in Long-Term care (HALT): a single-arm longitudinal study aiming to reduce inappropriate antipsychotic use in long-term care residents with behavioral and psychological symptoms of dementia
Halting Antipsychotic Use in Long-Term care (HALT): a single-arm longitudinal study aiming to reduce inappropriate antipsychotic use in long-term care residents with behavioral and psychological symptoms of dementia
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DOI：
10.1017/s1041610217000084
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发表时间：
2017-08-01
影响因子：
7
通讯作者：
Brodaty, Henry
中科院分区：
文献类型：
--
作者：
Jessop, Tiffany;Harrison, Fleur;Brodaty, Henry
背景：尽管修订了相关风险和副作用的指南和证据，但不适当地使用抗精神病药物来管理痴呆的行为和心理症状（BPSD）仍在继续。停止抗精神病药物使用长期护理（HALT）项目的目的是确定居民的长期护理（LTC）设施的抗精神病药物，并进行干预，以取消（或停止）这些药物，并改善非药理学行为management.Methods：LTC设施将在澳大利亚悉尼招募。住院医师入选标准将是年龄超过60岁，定期服用抗精神病药物，没有原发性精神病或非常严重的BPSD，使用神经精神量表（NPI）进行测量。数据收集将在开始取消处方前一个月零一周进行;以及3、6和12个月后进行。在停药前，将为护理人员提供如何使用以人为本的方法减少和管理BPSD的培训，并为参与者的全科医生提供学术细节。主要的结局指标将是减少常规抗精神病药物的使用，而不使用替代精神药物。次要结果的措施将是NPI总和域的分数，科恩-曼斯菲尔德激越量表评分和不良事件，包括福尔斯和hospitalization.Conclusion：虽然以前的研究已经描述了策略，以尽量减少不适当使用抗精神病药物的人与痴呆症生活在长期护理，可持续性和文化的BPSD在老年护理处方仍然是挑战。HALT项目旨在评估多学科方法在该人群中取消抗精神病药物处方的可行性。
Background:Inappropriate use of antipsychotic medications to manage Behavioral and Psychological Symptoms of Dementia (BPSD) continues despite revised guidelines and evidence for the associated risks and side effects. The aim of the Halting Antipsychotic Use in Long-Term care (HALT) project is to identify residents of long-term care (LTC) facilities on antipsychotic medications, and undertake an intervention to deprescribe (or cease) these medicines and improve non-pharmacological behavior management.Methods:LTC facilities will be recruited across Sydney, Australia. Resident inclusion criteria will be aged over 60 years, on regular antipsychotic medication, and without a primary psychotic illness or very severe BPSD, as measured using the Neuropsychiatric Inventory (NPI). Data collection will take place one month and one week prior to commencement of deprescribing; and 3, 6 and 12 months later. During the period prior to deprescribing, training will be provided for care staff on how to reduce and manage BPSD using person-centered approaches, and general practitioners of participants will be provided academic detailing. The primary outcome measure will be reduction of regular antipsychotic medication without use of substitute psychotropic medications. Secondary outcome measures will be NPI total and domain scores, Cohen-Mansfield Agitation Inventory scores and adverse events, including falls and hospitalizations.Conclusion:While previous studies have described strategies to minimize inappropriate use of antipsychotic medications in people with dementia living in long-term care, sustainability and a culture of prescribing for BPSD in aged care remain challenges. The HALT project aims to evaluate the feasibility of a multi-disciplinary approach for deprescribing antipsychotics in this population.