Gestructureerd farmacotherapie overleg: Een kosteneffectief middel om naleven van medicamenteuze richtlijnadviezen te bevorderen?

IMPLEMENTATION OBJECTIVE(S)/RESEARCH QUESTION(S):

The aim is to study if working with quality circles by pharmacotherapy counselling groups (PCGs) improves guideline adherence to the prescription of hypnotics and antipsychotics in nursing homes. In general, these classes of drugs are used too often and too long. The main research questions are: What is the effect of the implementation of quality circles as a working method in nursing home PCGs on guideline adherence to the prescription of hypnotics and antipsychotics? Is it cost-effective compared to pharmacotherapy counselling groups 'as usual'?



DESIGN, STUDY POPULATION:

The study will be a cluster randomized trial with 26 PCGs consisting of physicians and pharmacists. Both the intervention and the control group will consist of 13 PCGs.



INTERVENTION TO BE IMPLEMENTED:

The pharmacotherapy paragraph about hypnotics and antipsychotics of the guideline for problem behaviour.



IMPLEMENTATION ACTIVITIES/STRATEGY:

For a year PCGs will be trained and intensively supported to use quality circles during their meetings. Nursing staff will
participate in the intervention PCGs.



OUTCOME MEASURES & PROCESS INDICATORS:

Guideline adherence will be measured by prescription indicators. Primary outcome: percentage of residents using hypnotics and antipsychotics. An extensive process evaluation will be carried out to determine facilitators and barriers for the implementation of quality circles.



SAMPLE-SIZE CALCULATION/DATA ANALYSIS:

Based on a mean PCG-size of 10 physicians, two times 13 PCGs are necessary. Multilevel logistic regression and generalize estimated equations will be used for statistical analyses of the outcomes.



ECONOMIC EVALUATION:

An economic evaluation will be carried to study if the implementation of quality circles in PCGs is a cost-effective strategy to implement the pharmacotherapy paragraphs of the guideline for problem behaviour.



TIME SCHEDULE:

The study will take 3.5 years:

1. 0-12 months: Recruitment, development of educational material and indicators;

2. 13-30 months: Implementation of quality circles in PCGs, measurements;

3. 31-42 months: Analysis, writing papers, knowledge transfer.

Implementation of pharmacotherapy audit meetings (PTAMs) using quality circles will increase guideline adherence in nursing homes and result in improved quality of psychotropics-prescription in nursing homes.

Baseline, 3 monts, 6 months and 1 year.

The time points we are eventually interested in are baseline and 1 year.

Implementation of working with quality circles at level 3 or 4 in already existing pharmacotherapy audit meetings (PTAMs).



PTAMs of the intervention group will be trained and intensively supported in working with quality circles during their meetings for one year. Quality circles are defined as a cyclic method in which evidence-based information about prescription is provided to the participants and feedback on individual prescription is given. Participants discuss this information, reflect on the prescription data and make general treatment agreements. In consecutive meetings the results are evaluated by using prescription data. This can result in adjusted treatment agreements if target goals are not achieved. PTAMs using quality circles can be seen as a multifaceted implementation strategy. In this study the national guideline for problem behaviour of the Dutch Society of Elderly Care Physicians (Verenso) will be the source for evidence-based information about prescription of hypnotics and antipsychotics.

In PTAMs participate the pharmacist, all physicians and two representatives of the nursing staff of a nursing home organisation.



The control intervention is the 'usual way' of PTAMs: Not using working with quality circles or working with quality circles at a very low level (level 1 or 2).