The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial

Marie H Gedde, Bettina S Husebo, Janne Mannseth, Mala Naik, Geir Selbaek, Maarja Vislapuu, Line Iden Berge, Marie H Gedde, Bettina S Husebo, Janne Mannseth, Mala Naik, Geir Selbaek, Maarja Vislapuu, Line Iden Berge

Abstract

Background: There is limited knowledge regarding the process of deprescribing psychotropic drugs to people with dementia (PwD) conducted by general practitioners (GP). We investigated the impact of a multicomponent intervention, emphasizing medication reviews, on psychotropic drugs and behavioral and psychological symptoms (BPSD) in home-dwelling PwD and quantified change in patient-GP communication evaluated by their informal caregivers.

Methods: LIVE@Home.Path is a stepped-wedge closed-cohort cluster randomized controlled trial for people with mild to moderate dementia aged ≥65 and their informal caregivers (dyads) in Norway. Complementary to health care as usual (control condition), municipal coordinators implemented the multicomponent LIVE intervention: Learning, Innovation, Volunteer support, and Empowerment (including medication review by the PwD's regular GPs). Block-randomization was used to allocate dyads in three groups receiving the intervention sequentially in periods of 6 months duration. Prepandemic data from the first period is reported, resulting in a 1:2 intervention-to-control ratio. Primary outcome was change in psychotropic drug use. Secondary outcomes were changes in BPSD by Neuropsychiatric Inventory and Cornell Scale of Depression in Dementia and patient-GP communication by an adaption of the Clinical Global Impression of Change.

Results: Four hundred thirty-eight dyads were screened, 280 included, and 237 participated at 6 months (intervention group n=67; control condition n=170). At baseline, 63% used psychotropic medication regularly: antidementia drugs (47%), antidepressants (13%), hypnotics/sedatives (13%), antipsychotics (5%), and anxiolytics (2%). At 6 months, medication reviews were more frequently conducted in the intervention group compared to control (66% vs 42%, P=0.001). We found no differences regarding a change in drug use and BPSD. Patient-GP communication enhanced in the intervention group (mean score 0.95 [standard deviation 1.68] vs 0.41 [1.34], P=0.022). In the intervention group, control group, and overall sample, the informal caregivers of those who had their medications reviewed reported improved patient-GP communication compared to those who did not.

Conclusions: Change in psychotropic drug use and BPSD did not differ, even though patient-GP communication improved with medication reviews. Restricted psychotropic drug use among PwD likely reflects more judicious prescribing practices in recent years. Nevertheless, medication reviews could be cultivated to optimize pharmacologic treatment for this complex population.

Trial registration: ClinicalTrials.gov : NCT04043364 ; registered 15/03/2019.

Keywords: Behavioral and psychological symptoms of dementia; Dementia; Deprescribing; Home-dwelling; LIVE@Home.Path; Medication review; Multicomponent intervention; Neuropsychiatric symptoms; Psychotropic drugs.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The stepped-wedge closed-cohort randomized controlled LIVE@Home.Path trial during the COVID-19 pandemic. The COVID-19 pandemic temporarily halted the trial protocol at 6 months. This substudy includes all dyads (people with dementia and informal caregivers) who completed the first 6-month period, solely analyzing prepandemic data. In this first 6-month period, dyads randomized to Group 1 received the LIVE (Learning, Innovation, Volunteer support, and Empowerment) intervention while dyads randomized to Group 2 and Group 3 served as controls receiving health care as usual
Fig. 2
Fig. 2
Flow diagram. Dyad (people with dementia and informal caregivers, n) flow during the first 6-month period of the LIVE@Home.Path trial
Fig. 3
Fig. 3
Reach of medication reviews. Conduction of medication reviews for people with dementia (n (%)) during the first 6-month period of the LIVE@Home.Path trial
Fig. 4
Fig. 4
Change in patient-general practitioner (GP) communication by medication reviews. Patient-GP communication as perceived by the informal caregivers stratified on whether medication reviews were conducted for people with dementia (n) during the first 6-month period of the LIVE@Home.Path trial. CGIC: Clinical Global Impression of Change, range −5–5, negative value: worsening, positive value: improvement. P values for difference in mean, marked * if <0.05, and 95% confidential interval by the unequal variances t-test

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