Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes
Abstract Background Antipsychotic medication use in nursing homes is associated with potential for harms. In Ontario, Canada, an agency of the provincial government offers nursing home physicians quarterly audit and feedback on their antipsychotic prescribing. We compared the characteristics of phys...
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-020-00013-9 |
| _version_ | 1818370245271748608 |
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| author | Noah M. Ivers Monica Taljaard Vasily Giannakeas Catherine Reis Cara L. Mulhall Jonathan M.C. Lam Ann N. Burchell Gerald Lebovic Susan E. Bronskill |
| author_facet | Noah M. Ivers Monica Taljaard Vasily Giannakeas Catherine Reis Cara L. Mulhall Jonathan M.C. Lam Ann N. Burchell Gerald Lebovic Susan E. Bronskill |
| author_sort | Noah M. Ivers |
| collection | DOAJ |
| description | Abstract Background Antipsychotic medication use in nursing homes is associated with potential for harms. In Ontario, Canada, an agency of the provincial government offers nursing home physicians quarterly audit and feedback on their antipsychotic prescribing. We compared the characteristics of physicians who did and did not engage with the intervention, and assessed early changes in prescribing. Methods This population-level, retrospective cohort study used linked administrative databases to track prescribing practices in nursing homes pre-intervention (baseline), immediately post-initiative (3 months), and at follow-up (6 months). Exposure variables identified whether a physician signed up to participate (or not) or viewed the feedback following sign up (or not). Differences in the proportion of days that residents received antipsychotic medications at 6 months compared to baseline by exposure(s) were assessed using a linear mixed effects regression analysis to adjust for a range of resident, physician, and nursing home factors. Benzodiazepine and statin prescribing were assessed as a balance and tracer measures, respectively. Results Of 944 eligible physicians, 210 (22.3%) signed up to recieve the feedback report and 132 (13.9%) viewed their feedback. Physicians who signed up for feedback were more likely to have graduated from a Canadian medical school, work in urban nursing homes, and care for a larger number of residents. The clinical and functional characteristics of residents were similar across physician exposure groups. At 6 months, antipsychotic prescribing had decreased in all exposure groups. Those who viewed their feedback report had a signicantly greater reduction in antipsychotic prescribing than those who did not sign up (0.94% patient-days exposed; 95% CI 0.35 to 1.54%, p = 0.002). Trends in prescribing patterns across exposure groups for benzodiazepines and statins were not statistically significant. Interpretation Almost a quarter of eligible physicians engaged early in a voluntary audit and feedback intervention related to antipsychotic prescribing in nursing homes. Those who viewed their feedback achieved a small but statistically significant change in prescribing, equivalent to approximately 14,000 fewer days that nursing home residents received antipsychotic medications over 6 months. This study adds to the literature regarding the role of audit and feedback interventions to improve quality of care. |
| first_indexed | 2024-12-13T23:36:40Z |
| format | Article |
| id | doaj.art-0483dea7ee204f2d9b35cbf46f43439a |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-13T23:36:40Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-0483dea7ee204f2d9b35cbf46f43439a2022-12-21T23:27:17ZengBMCImplementation Science Communications2662-22112020-02-011111410.1186/s43058-020-00013-9Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homesNoah M. Ivers0Monica Taljaard1Vasily Giannakeas2Catherine Reis3Cara L. Mulhall4Jonathan M.C. Lam5Ann N. Burchell6Gerald Lebovic7Susan E. Bronskill8Women’s College Research Institute, Women’s College HospitalSchool of Epidemiology and Public Health, University of OttawaWomen’s College Research Institute, Women’s College HospitalWomen’s College Research Institute, Women’s College HospitalHealth System Performance, Ontario Health (Quality)Health System Performance, Ontario Health (Quality)ICESInstitute of Health Policy, Management and Evaluation, University of TorontoWomen’s College Research Institute, Women’s College HospitalAbstract Background Antipsychotic medication use in nursing homes is associated with potential for harms. In Ontario, Canada, an agency of the provincial government offers nursing home physicians quarterly audit and feedback on their antipsychotic prescribing. We compared the characteristics of physicians who did and did not engage with the intervention, and assessed early changes in prescribing. Methods This population-level, retrospective cohort study used linked administrative databases to track prescribing practices in nursing homes pre-intervention (baseline), immediately post-initiative (3 months), and at follow-up (6 months). Exposure variables identified whether a physician signed up to participate (or not) or viewed the feedback following sign up (or not). Differences in the proportion of days that residents received antipsychotic medications at 6 months compared to baseline by exposure(s) were assessed using a linear mixed effects regression analysis to adjust for a range of resident, physician, and nursing home factors. Benzodiazepine and statin prescribing were assessed as a balance and tracer measures, respectively. Results Of 944 eligible physicians, 210 (22.3%) signed up to recieve the feedback report and 132 (13.9%) viewed their feedback. Physicians who signed up for feedback were more likely to have graduated from a Canadian medical school, work in urban nursing homes, and care for a larger number of residents. The clinical and functional characteristics of residents were similar across physician exposure groups. At 6 months, antipsychotic prescribing had decreased in all exposure groups. Those who viewed their feedback report had a signicantly greater reduction in antipsychotic prescribing than those who did not sign up (0.94% patient-days exposed; 95% CI 0.35 to 1.54%, p = 0.002). Trends in prescribing patterns across exposure groups for benzodiazepines and statins were not statistically significant. Interpretation Almost a quarter of eligible physicians engaged early in a voluntary audit and feedback intervention related to antipsychotic prescribing in nursing homes. Those who viewed their feedback achieved a small but statistically significant change in prescribing, equivalent to approximately 14,000 fewer days that nursing home residents received antipsychotic medications over 6 months. This study adds to the literature regarding the role of audit and feedback interventions to improve quality of care.https://doi.org/10.1186/s43058-020-00013-9Antipsychotic prescribingNursing homesInterrupted time seriesAudit and feedback |
| spellingShingle | Noah M. Ivers Monica Taljaard Vasily Giannakeas Catherine Reis Cara L. Mulhall Jonathan M.C. Lam Ann N. Burchell Gerald Lebovic Susan E. Bronskill Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes Implementation Science Communications Antipsychotic prescribing Nursing homes Interrupted time series Audit and feedback |
| title | Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes |
| title_full | Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes |
| title_fullStr | Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes |
| title_full_unstemmed | Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes |
| title_short | Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes |
| title_sort | effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes |
| topic | Antipsychotic prescribing Nursing homes Interrupted time series Audit and feedback |
| url | https://doi.org/10.1186/s43058-020-00013-9 |
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