THE IMPACT OF REGULAR MULTIDISCIPLINARY TEAM INTERVENTIONS ON PSYCHOTROPIC PRESCRIBING IN SWEDISH NURSING-HOMES

OBJECTIVE: To evaluate the impact of regular multidisciplinary team in terventions on the quantity and quality of psychotropic drug prescribi ng in Swedish nursing homes. DESIGN: A randomized controlled trial. SE TTING: A sample of 33 nursing homes: 15 experimental homes and 18 cont rol homes representing 5% of all Swedish nursing homes. PARTICIPANTS: The sample consisted of 1854 long-term care residents with an average age of 83 years. Seventy percent of the residents were women, and 42% had a documented diagnosis of dementia. An additional 5% had a psychot ic disorder, and 7% had a diagnosis of depression. INTERVENTION: Exper imental homes participated in an outreach program that was designed to influence drug use through improved teamwork among physicians, pharma cists, nurses, and nurses' assistants. Multidisciplinary team meetings were held on a regular basis throughout the 12-month study period. ME ASUREMENTS: Lists of each resident's prescriptions were collected 1 mo nth before and 1 month after the 12-month intervention. Measures inclu ded the proportion of residents with any psychotropic drug, polymedici ne, and therapeutic duplication and proportion of residents with nonre commended and acceptable drugs in each psychotropic drug class, as def ined by current Swedish guidelines. RESULTS: Baseline results show ext ensive psychotropic drug prescribing, with the most commonly prescribe d drugs being hypnotics (40%), anxiolytics(40%), and antipsychotics (3 8 %). After 12 months of team meetings in the experimental homes, ther e was a significant decrease in the prescribing of psychotics (-19%), benzodiazepine hypnotics (-37%), and antidepressants (-59%). Orders fo r more acceptable antidepressants also increased in the experimental h omes. In the control homes there was increased use of acceptable antid epressants, but there were no significant reductions in other drug cla sses. CONCLUSIONS: There is excessive prescription of psychotropic dru gs in Swedish nursing homes. Improved teamwork among caregivers can im prove prescribing as defined by clinical guidelines.