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Reports on the way doctors prescribe antipsychotic medications in nursing homes change prescribing habits


Patients cared for by physicians who viewed physician-level reports on their prescribing habits were exposed to thousands of fewer days of high-risk medications within six months of their physician receiving the feedback, according to new research from ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues.

The study published today in Implementation Science Communications, evaluates whether the ‘report cards’ sent by Health Quality Ontario to physicians is leading to improvements in quality of care. For many years, Health Quality Ontario (now known as Ontario Health(Quality)) has been providing physicians with the opportunity to learn about how their practice compares to others in the province.

“Our study really focuses on whether the initial release of those report cards to physicians working in nursing homes helped to shift prescribing habits away from medications known to be unsafe for those patients,” says Dr. Noah Ivers, lead author on the study, family physician at Women’s College Hospital and adjunct scientist at ICES.

Physicians can choose to sign up to receive the report cards and to spend time looking at the data provided or not. The researchers found that amongst the doctors who viewed their data, improvements in prescribing were greater than those who did not sign up. The study also found that the majority of physicians did not sign up or look at the feedback.

Almost a quarter (22.3 per cent) of eligible physicians engaged early in a voluntary audit and feedback intervention (report cards) related to antipsychotic prescribing in nursing homes. Those who viewed their feedback (14 per cent) did change their prescribing, equivalent to approximately 14,000 fewer days that nursing home residents received antipsychotic medications over six months.

“Essentially, our study shows that the effects of the report cards depend on the engagement the physician had with the feedback,” says Dr. Ivers.

The researchers add that evaluation of provincial initiatives are important to measure the current state of the healthcare system.

“This approach can be helpful, but there are important challenges for fully maximizing the potential of these types of initiatives. It is essential that physicians have the resources they need to see how to best help their patients and to ensure our system is continuously improving,” says Susan Bronskill, senior author on the study and senior core scientist at ICES.

This project is part of a partnership with Ontario Health, Quality business unit in the implementation science laboratory. The researchers also produced a companion report to this study showing that the reports are good value for money for the healthcare system and have multiple experimental studies in progress testing different ways to optimize the reports.

The study “Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes,” was published in the journal Implementation Science Communications.

Author block: Noah Michael Ivers, Monica Taljaard, Vasily Giannakeas, Catherine Reis, Cara Mulhall, Jonathan M.C. Lam, Ann N Burchell, Gerald Lebovic and Susan E Bronskill.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

Women’s College Hospital
For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of health equity, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole.

Women’s College Research Institute (WCRI) is tackling some of the greatest health challenges of our time. Its scientists are conducting global research that advances the health of women and improves healthcare options for all, and are then translating those discoveries to provide much-needed improvements in healthcare worldwide.

For more information about how WCH and WCRI are transforming patient care, visit www.womenscollegehospital.ca and www.womensresearch.ca


Deborah Creatura
Media Advisor, ICES
[email protected]

Jordan Benadiba
Women’s College Hospital
[email protected]

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