Optimizing Practices, Use, Care and Services‐Antipsychotics (OPUS‐AP): A phase 2 scale‐up to 129 long‐term care (LTC) centers in Quebec, Canada

Abstract

Background: Antipsychotics are often used for the first-line management of behavioral and psychological symptoms of dementia (BPSD) despite risks and side effects, and with disregard for guidelines recommendations to prioritize non-pharmacological interventions. In phase 1 of OPUS-AP, conducted in 24 long-term care (LTC) centers in Quebec, Canada, antipsychotic deprescribing (cessation or dose decrease) was achieved in 85,5% of residents in whom it was attempted (Cossette et al. JAMDA, 2019). Methods: Phase 2 of OPUS-AP was conducted in 129 LTC centres in Quebec, Canada, from April to December 2019. OPUS-AP aims at improving resident care through increased staff's knowledge and competency, resident-centered approaches, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications. Antipsychotic, benzodiazepine, antidepressant prescriptions and BPSD were evaluated every 3 months for 9 months. Results: At baseline, 10,601 residents were admitted on OPUS-AP participating wards from which 74% had a diagnosis of major neurocognitive disorder (MNCD) and 47% an antipsychotic prescription. The follow-up cohort included 4,087 residents with both MNCD and antipsychotic prescription. Among the 1216 residents still included at 6 months and in whom antipsychotic deprescribing was attempted between baseline and 6 months and, successful deprescribing (at 3- or 6-month follow-up) was achieved in 85.6% (cessation 50.0% or dose decrease 35.6%). No increase in benzodiazepine or antidepressant prescriptions nor worsening of BPSD were observed. Conclusions: Phase 2 of OPUS-AP confirmed phase 1 results of successful antipsychotic deprescribing with scale-up to 129 LTC centers. Phase 3 of OPUS-AP is underway in 2020 in all of Quebec's 341 public LTC centers.