Observational studyBMJ open2016
Antipsychotic prescribing in care homes before and after launch of a national dementia strategy: an observational study in English institutions over a 4-year period.
Observational study in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Factors associated with the variation in drug prescription of antipsychotics in long-term care facilities: a systematic review.BMC geriatrics · 2025Pooled it
- Barriers and Facilitators to Implementing Cognitive Stimulation and Reminiscence Therapy for Dementia in Care Homes: Systematic Review.International journal of geriatric psychiatry · 2025Pooled it
- Stakeholders' views on the use of psychotropic medication in older people: a systematic review.Age and ageing · 2022Pooled it
- Inequalities in the Quality and Safety of Post-Diagnostic Primary Care for People With Dementia: A Scoping Review.International journal of geriatric psychiatry · 2024Article
- Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study.BMJ (Clinical research ed.) · 2024Article
- Psychotropic Medication Prescribing to Patients with Dementia Admitted to Acute Hospitals in Ireland.Drugs & aging · 2023Article
- The Prevalence of and Documented Indications for Antipsychotic Prescribing in Irish Nursing Homes.Pharmacy (Basel, Switzerland) · 2021Article
- Associations between COVID-19 and 30-day thromboembolic events and mortality in people with dementia receiving antipsychotic medications.Pharmacological research · 2021Article
- Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection.BMC psychiatry · 2020Article
- National Partnership to Improve Dementia Care in Nursing Homes Campaign: State and Facility Strategies, Impact, and Antipsychotic Reduction Outcomes.Innovation in aging · 2020Article
- Approaches to Deprescribing Psychotropic Medications for Changed Behaviours in Long-Term Care Residents Living with Dementia.Drugs & aging · 2019Review
- Article
- Adverse Drug Reactions, Power, Harm Reduction, Regulation and the ADRe Profiles.Pharmacy (Basel, Switzerland) · 2018Article
- Article
- Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study.BJPsych open · 2017Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess associations between the launch of the National Dementia Strategy (NDS) and antipsychotic prescribing in long-term residential care (LTC) in England. SETTING AND
participantsRetrospective analysis of prescribing patterns in 616 LTC institutions (31 619 residents) following launch of the NDS, using information from electronic medicines management system. PRIMARY AND SECONDARY OUTCOME MEASURES: Antipsychotic prescribing point prevalence (PP) for all residents in a cross section of LTC settings over a 4-year period following NDS launch. Secondary outcomes included dosages, length of treatment and use of recommended second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs). Associations between facility-level PP values and institutional characteristics, resident demographics were explored. Variations across geographical areas examined. Prescription net ingredient costs calculated.
resultsNo statistically significant difference was observed in overall prescribing rates over the 4-year period (Kolmogorov-Smirnov (KS) test p=0.60), and there was no significant shift towards newer SGAs (KS test p=0.32). Dosages were above the maximum indicated in only 1.3% of cases, but duration of prescribing was excessive in 69.7% of cases. Care homes in the highest prescribing quintile were more likely to be located in a deprived area (rate ratio (Q5/Q1) RR=5.89, 95% CI 4.35 to 7.99), registered for dementia (RR=3.38, 95% CI 3.06 to 3.73) and those in the lowest quintile were more likely to be served by a single general practitioner (GP) practice (RR=0.48; 95% CI 0.37 to 0.63); p<0.001 all. A sixfold variation in PP levels was observed between geographical areas. The average annual expenditure on antipsychotics was £65.6 per person resident (2012 prices).
conclusionsThe NDS in England was not associated with reduced PP levels or the types of antipsychotic prescribing in care homes. Further research is needed to explore why. Clear standards specifying recommended agents, dosages and length of treatment, together with routine monitoring and greater accountability for antipsychotic prescribing, may be required.
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