Rationalising antipsychotic prescribing in dementia: a mixed-methods investigation

Walsh, Kieran A.

Rationalising antipsychotic prescribing in dementia: a mixed-methods investigation

dc.check.chapterOfThesis	6,7,8
dc.check.date	2022-02-05T12:57:59Z
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
dc.check.info	Restricted to everyone for three years	en
dc.check.opt-out	Not applicable	en
dc.check.reason	This thesis is due for publication or the author is actively seeking to publish this material	en
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.contributor.funder	Health Research Board	en
dc.contributor.funder	Atlantic Philanthropies	en
dc.date.accessioned	2019-02-06T12:57:59Z
dc.date.issued	2019
dc.date.submitted	2019
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.description.status	Not peer reviewed	en
dc.description.version	Accepted Version
dc.format.mimetype	application/pdf	en
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	https://hdl.handle.net/10468/7451
dc.language.iso	en	en
dc.publisher	University College Cork	en
dc.relation.project	Health Research Board (SPHeRE/2013/1)	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.thesis.opt-out	false
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
ucc.workflow.supervisor	s.timmons@ucc.ie