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Factors Related to Psychotropic Drug Prescription for Neuropsychiatric Symptoms in Nursing Home Residents With Dementia

  • Claudia H.W. Smeets
    Correspondence
    Address correspondence to Claudia H.W. Smeets, MSc, or Debby L. Gerritsen, PhD, Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Code 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
    Affiliations
    Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
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  • Martin Smalbrugge
    Affiliations
    Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
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  • Sytse U. Zuidema
    Affiliations
    Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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  • Els Derksen
    Affiliations
    Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
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  • Erica de Vries
    Affiliations
    Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
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  • Klaas van der Spek
    Affiliations
    Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
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  • Raymond T.C.M. Koopmans
    Affiliations
    Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands

    Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
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  • Debby L. Gerritsen
    Correspondence
    Address correspondence to Claudia H.W. Smeets, MSc, or Debby L. Gerritsen, PhD, Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Code 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
    Affiliations
    Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
    Search for articles by this author

      Abstract

      Objectives

      The objective of this study is to explore factors that elucidate reasons for psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home (NH) residents with dementia.

      Design

      A qualitative study using a grounded theory approach.

      Setting

      Twelve NHs in The Netherlands.

      Participants

      Fifteen physicians and 14 nurses.

      Measurements

      Individual, face-to-face, in-depth semistructured interviews. Interviews were audio-recorded, transcribed, and qualitatively analyzed using Atlas.ti.

      Results

      The qualitative analysis revealed 4 emerging themes with factors either or both enhancing or limiting PD prescription, which we used to develop a conceptual framework. First, the mindset of physicians and nurses toward NPS and PDs appeared to contribute. Second, inadequate knowledge of and experience with NPS and limited people skills of nurses may induce PD prescription. Also, knowledge of effectiveness and side effects of PDs from education, literature, and guidelines, and previous personal experiences was considered relevant. Third, effective communication and cooperation between professionals and with family may improve the appropriateness of PD prescription. Fourth, external factors including staffing issues, nursing home setting, access to consultants, national and local policies, and zeitgeist were considered to affect PD prescription.

      Conclusion

      We have developed a conceptual framework explaining how different factors influence PD prescription. This provides opportunities for improving PD prescription in NH residents with dementia.

      Keywords

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