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Implementing a multidisciplinary psychotropic medication review among nursing home residents with dementia: a process evaluation

Published online by Cambridge University Press:  27 August 2019

Debby L. Gerritsen ,
Erica de Vries ,
Martin Smalbrugge ,
Claudia H. W. Smeets ,
Klaas van der Spek ,
Sytse U. Zuidema  and
Raymond T. C. M. Koopmans
Debby L. Gerritsen*
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands Radboud Institute for Health Sciences, Nijmegen, the Netherlands
Erica de Vries
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
Martin Smalbrugge
Affiliation:
Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
Claudia H. W. Smeets
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands Radboud Institute for Health Sciences, Nijmegen, the Netherlands
Klaas van der Spek
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
Sytse U. Zuidema
Affiliation:
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
Raymond T. C. M. Koopmans
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands De Waalboog, Specialized Geriatric Care Centre ‘Joachim en Anna,’ Nijmegen, the Netherlands
*
Correspondence should be addressed to: Debby L. Gerritsen, Department of Primary and Community Care, Radboud University Medical Center, Code 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. Phone: +31 24 361 95 88. Email: debby.gerritsen@radboudumc.nl.
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Abstract

Objectives:

Before drawing conclusions on the contribution of an effective intervention to daily practice and initiating dissemination, its quality and implementation in daily practice should be optimal. The aim of this process evaluation was to study these aspects alongside a randomized controlled trial investigating the effects of a multidisciplinary biannual medication review in long-term care organizations (NTR3569).

Design:

Process evaluation with multiple measurements.

Setting:

Thirteen units for people with dementia in six long-term care organizations in the Netherlands.

Participants:

Physicians, pharmacists, and nursing staff of participating units.

Intervention:

The PROPER intervention is a structured and biannually repeated multidisciplinary medication review supported by organizational preparation and education, evaluation, and guidance.

Measurements:

Web-based questionnaires, interviews, attendance lists of education sessions, medication reviews and evaluation meetings, minutes, evaluation, and registration forms.

Results:

Participation rates in education sessions (95%), medication reviews (95%), and evaluation meetings (82%) were high. The intervention’s relevance and feasibility and applied implementation strategies were highly rated. However, the education sessions and conversations during medication reviews were too pharmacologically oriented for several nursing staff members. Identified barriers to implementation were required time, investment, planning issues, and high staff turnover; facilitators were the positive attitude of professionals toward the intervention, the support of higher management, and the appointment of a local implementation coordinator.

Conclusion:

Implementation was successful. The commitment of both higher management and professionals was an important factor. This may partly have been due to the subject being topical; Dutch long-term-care organizations are pressed to lower inappropriate psychotropic drug use.

Keywords

barriers and facilitatorsimplementation strategiesintervention qualitylong-term carenursing staffpsychoactive drugs
Type
Original Research Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 9: Issue Theme: Implementation Science II , September 2021 , pp. 933 - 945
Copyright
© International Psychogeriatric Association 2019

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Footnotes

*

Equal contribution

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