A 2018/2019 Summer Studentship research project
More detailed information about who is prescribing and why is needed to help plan targeted interventions to reduce the use of antipsychotics to manage behaviour in residential care. Knowing how much of antipsychotic prescribing is in the context of care for people who are dying may significantly impact on how we interpret information about antipsychotic prescribing rates, and even how we do and interpret research on whether being prescribed these medications increases the risk of dying.
Student: Tessa Luff
Supervisors: Susan Gee, Matthew Croucher
Sponsor: Canterbury District Health Board – Older Persons Mental Health Research Trust
A number of concerns have been expressed about the potential overuse of antipsychotic medications in the older population to manage behaviours that challenge amongst people living with a dementia in residential care (e.g., BPAC, 2011; Mayer et al., 2011). While information is readily available about how often antipsychotics are prescribed, we know much less about why they are being prescribed or who is doing the prescribing (Mark, 2010). Previous research by our team in 2012 found that only 19% of the antipsychotic prescriptions for older people were to help to manage behaviours that challenge amongst people living with a dementia in residential care. Surprisingly, 40% of the prescriptions were given to help manage nausea and agitation for people who are terminally ill, a use that has been overlooked in the literature.
Shortly after that study, in 2013, the Liverpool Care end-of-life care pathway was discontinued in the UK and New Zealand due to concerns about way the pathway was being implemented, including the use of antipsychotic medication for deep sedation. It is unknown what, if any, impact the subsequent revision of palliative care guidelines has had on antipsychotic prescribing.
The aim of this study is to explore why antipsychotic medications are being prescribed to older people in Canterbury in 2018, who the key players in the prescription decision are, and the degree to which prescribing has changed since 2012.
We will extract a list from the national Pharmaceutical Collection Data Warehouse of all new community prescriptions for antipsychotic medication in Canterbury for people aged 65 and over for the period from July to September 2018. The prescribers will be sent a single page audit form to find out the reason and context for the prescription. Analysis will include describing the patterns of use, and comparing the results to those from 2012.
Student researcher’s component of the study
The study will be completed within the studentship time frame. The student will have the opportunity to gain supported experience in survey-based data collection, data entry and management, analysis, and interpretation, as well as an overall introduction to the process of clinical audit. The student will also gain experience in conducting research in a health care setting including issues such as understanding privacy and maintaining confidentiality.
The student’s role will include:
- Familiarisation with key work in the area
- Management of sampling frame and results database
- Management of the postal audit
- Participation in the analysis and interpretation of results
- Contributing to the dissemination of results