275396
Dissemination of evidence-based atypical antipsychotic information to nursing homes
Tuesday, November 5, 2013
: 10:30 AM - 10:42 AM
Jennifer Tjia, MD, MSCE
,
Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
Sarah Foy, BA
,
Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
Kathleen M. Mazor, EdD
,
Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
Terry S. Field, DSc
,
Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
Abir O. Kanaan, PharmD
,
Massachusetts College of Pharmacy, Worcester, MA
Jennifer L. Donovan, PharmD
,
Massachusetts College of Pharmacy, Worcester, MA
Jerry H. Gurwitz, MD
,
Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
Accumulating evidence demonstrates minimal benefit and increased risk of off-label use of atypical antipsychotic medications for dementia-related behaviors. The optimal strategy for disseminating evidence-based guides to nursing home (NH) stakeholders is unclear. Our objective is to describe the impact of differing dissemination efforts in Connecticut NHs. Forty-three Connecticut NHs were randomized to 1 of 3 arms receiving incrementally intensive dissemination strategies of the AHRQ Comparative Effectiveness Review Summary Guide on the off-label use of atypical antipsychotic drugs, which was included in a toolkit informed by a needs assessment of NHs. All NHs received the paper-based toolkit and notifications regarding the online toolkit. Additionally, Arm 2 received individualized quarterly audit and feedback (A/F) reports with atypical antipsychotic prescribing rates. Arm 3 received in-person educational visits and A/F reports. Toolkit reach was assessed using interviews with NH leadership and staff. Online toolkit use was assessed using Google analytics. Fifty-eight leaders and 192 direct care staff were interviewed. Leadership and direct care staff in Arm 3 NHs were more likely to be familiar with the toolkit than those in Arm 1 (p=0.008) and Arm 2 (p<0.0001). Several leaders and direct care staff identified the patient-centered behavior management section of the toolkit as the most useful. Google analytics showed no difference in the use of the online toolkit among NHs (p=0.30). Intensive dissemination, using a multi-pronged approach including academic detailing and staff trainings, appeared to be associated with higher familiarity with paper-based toolkit, but not Internet-based use of the toolkit in the NH setting.
Learning Areas:
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Learning Objectives:
Identify challenges to dissemination of evidence-based guidelines in the nursing home setting.
Describe the impact of paper-based, Internet-based, and in-person educational dissemination efforts in 43 nursing homes in Connecticut.
Keywords: Evidence Based Practice, Dementia
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I have been the Project Manager for this project for the last 2 years and have been involved in all aspects of its implementation. I worked with other team members to develop the interviews and surveys for the needs assessment as well as the interview guide used for this project. I have extensive experience in both clinical and research environments. I have a sound knowledge of research design, program development, and program evaluation.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
Register for the meeting now