275396
Dissemination of evidence-based atypical antipsychotic information to nursing homes
Tuesday, November 5, 2013
: 10:30 a.m. - 10:42 a.m.
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
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.
Keyword(s): 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.
