Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes
Ivers NM, Taljaard M, Giannakeas V, Reis C, Mulhall CL, Lam JMC, Burchell AN, Lebovic G, Bronskill SE. Implement Sci Commun. 2020; 1:12. Epub 2020 Feb 24. DOI: https://doi.org/10.1186/s43058-020-00013-9
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 six months compared to baseline by exposure(s) was 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 receive 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 six months, antipsychotic prescribing had decreased in all exposure groups. Those who viewed their feedback report had a significantly 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 six months.
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