Rationalising antipsychotic prescribing in dementia: a mixed-methods investigation

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dc.contributor.advisor Timmons, Suzanne en
dc.contributor.advisor Byrne, Stephen en
dc.contributor.advisor Browne, John P. en
dc.contributor.advisor McSharry, Jenny en
dc.contributor.author Walsh, Kieran A.
dc.date.accessioned 2019-02-06T12:57:59Z
dc.date.issued 2019
dc.date.submitted 2019
dc.identifier.citation Walsh, K. 2019. Rationalising antipsychotic prescribing in dementia: a mixed-methods investigation. PhD Thesis, University College Cork. en
dc.identifier.endpage 424 en
dc.identifier.uri http://hdl.handle.net/10468/7451
dc.description.abstract Introduction: Antipsychotics are commonly prescribed to people with dementia, especially in nursing homes, despite limited benefits and significant harms. There have been calls to better understand the reasons why antipsychotics continue to be inappropriately prescribed to people with dementia, and to develop sustainable interventions. Hence the overarching aim of this thesis was to develop and assess the feasibility of a theoretically-informed, evidence-based and sustainable intervention to rationalise (or optimise) antipsychotic prescribing in nursing home residents with dementia. Methods: The overarching Medical Research Council (MRC) framework for developing and evaluating complex interventions guided our approach to this mixed-methods research. Firstly, a systematic review was undertaken to determine the effectiveness of pharmacists’ intervention in improving the appropriateness of prescribing in hospitalised older adults, with a particular focus on people with dementia. Secondly, a retrospective cross-sectional study was conducted examining prescribing differences between older adults with and without dementia, on admission to hospital. Next, a systematic review of qualitative evidence was undertaken to explore the influences on decision-making regarding antipsychotic prescribing in nursing home residents with dementia, which subsequently informed a semi-structured interview study exploring antipsychotic prescribing behaviours. The Behaviour Change Wheel (BCW) was then used to develop a complex intervention with Patient and Public Involvement (PPI) throughout. Finally, a feasibility study of the novel intervention was conducted in a nursing home setting. Results: Despite the fact that our cross-sectional study showed that hospitalised adults with dementia were prescribed significantly more antipsychotics, our systematic review found no pharmacist intervention existed which aimed to improve the quality of prescribing in this population. Our qualitative synthesis highlighted the complexity of decision-making with regards antipsychotic prescribing to nursing home residents with dementia. The interview study identified determinants influencing prescribing behaviours. Based on these findings, we developed the ‘Rationalising Antipsychotic Prescribing in Dementia’ (RAPID) complex intervention which consisted of academic detailing with general practitioners, education and training with nursing home staff, and an assessment tool. This intervention was found to be both feasible and acceptable, however limited uptake of the assessment tool compromised intervention implementation. Conclusion: This thesis has made a significant original contribution to knowledge, generating a much needed conceptual understanding of this complex issue and contributing towards intervention development. Further research is required to evaluate the effectiveness and sustainability of our novel intervention through larger scale evaluations. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2019, Kieran Walsh. en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en
dc.subject Dementia en
dc.subject Antipsychotics en
dc.subject Mixed-methods en
dc.subject Inappropriate prescribing en
dc.subject Nursing homes en
dc.subject Behaviour change wheel en
dc.subject Older persons en
dc.subject Systematic reviews en
dc.title Rationalising antipsychotic prescribing in dementia: a mixed-methods investigation en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral en
dc.type.qualificationname PhD en
dc.internal.availability Full text not available en
dc.check.info Restricted to everyone for three years en
dc.check.date 2022-02-05T12:57:59Z
dc.description.version Accepted Version
dc.contributor.funder Health Research Board en
dc.contributor.funder Atlantic Philanthropies en
dc.description.status Not peer reviewed en
dc.internal.school Pharmacy en
dc.internal.school Public Health en
dc.check.reason This thesis is due for publication or the author is actively seeking to publish this material en
dc.check.opt-out Not applicable en
dc.thesis.opt-out false
dc.check.chapterOfThesis 6,7,8
dc.check.embargoformat Apply the embargo to the e-thesis on CORA (If you have submitted an e-thesis and want to embargo it on CORA) en
ucc.workflow.supervisor s.timmons@ucc.ie
dc.internal.conferring Spring 2019 en
dc.internal.ricu Centre for Gerontology and Rehabilitation en
dc.relation.project Health Research Board (SPHeRE/2013/1) en

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© 2019, Kieran Walsh. Except where otherwise noted, this item's license is described as © 2019, Kieran Walsh.
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