of Innovations in Healthcare Tanya Mac Donald April 15 2019 - - PowerPoint PPT Presentation

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Accelerating the Spread and Scale

• f Innovations in Healthcare

Tanya Mac Donald

April 15 2019

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Disclosure

I have no actual or potential conflict of interest in relation to this topic or presentation.

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OUR GOALS & OBJECTIVES

Appropriate Use of Antipsychotics in Long Term Care

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Context

Prevalence of dementia :

• The prevalence of dementia is higher in long-term care facilities than in the overall senior population (CIHI

report, 2016).

• The majority of residents living with dementia will present with at least one behavioural and psychological

symptom of dementia (BPSD); which is challenging for both caregivers and staff.  Symptoms include agitation, aggression, euphoria, disinhibition, irritability, anxiety, delirium and hallucinations Use of Antipsychotics:

• Estimated rates of inappropriate antipsychotic use among Canadian long-term care residents (excluding residents

with psychosis) is approximately 30.3%; with higher use among residents with severe cognitive impairment (2012-2014 data, CIHI report 2016).

• Antipsychotics are associated with an increased risk of side effects such as sedation, falls, fractures, stroke and

even death (CIHI report, 2016)

• Non-pharmacological interventions should be first-line treatment for the management of BPSD in this

population.

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The Innovation

 Appropriate use of antipsychotics :

1) Identification of residents appropriate for deprescribing 2) Systematic medication reviews by the team 3) Identification and observation of behaviours in partnership with the family 4) Implementation of non-pharmacological approaches based on resident’s history 5) Application of deprescibring guidelines 6) Monitor and evaluate

 The goal: Prioritize and improve the use person-centered approaches to care for residents living in long-term care with a diagnosis of dementia and reduce the inappropriate use of antipsychotics.

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Provincial Scale Collaboratives

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How?

Provincial Partnership Measurement Seed Funding Peer to Peer Exchange Training Implementation support Tools and Resources

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Health of Populations

• Pan Canadian:
• 54% reduced or discontinued use of

antipsychotics

• New Brunswick (phases 1 and 2):
• 52% reduced or discontinued use of

antipsychotics

• Quebec (Phase I)
• 86 % reduced or discontinued use of

antipsychotics Key message: No impact on behaviours

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Experience of Care

• Residents and Families:
• Improved quality of life of residents
• Improved relationships with families
• Increased ability to participate in activities of

daily living

• Care providers:
• Increased interprofessional collaboration
• Increased awareness of team members roles
• Increased communication between providers
• Increase use of non-pharmacological

interventions (culture change)

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Value for Money/Appropriateness

• f Resources

› Implementation of non-pharmacological approaches to care as first line intervention › Appropriate prescribing practices › Decreased potential for adverse events related to inappropriate antipsychotic use.

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Success Factors

 Alignment with provincial priorities and leverage provincial resources

(experts, training, tools, etc.).

 Opportunity to co-design the provincial spread and scale of health

innovations (robust practice that is adaptive to each provincial context).

 Opportunity to learn from each provincial spread and scale collaborative and

apply those learnings to inform future programs; and to share within provinces.

 Building capacity within the provinces that can be applied to future local

improvement work.

 Importance of fostering meaningful engagement with residents and families

as a driver for change.

« I am less aggressive and I can move better. I can also eat and drink better. » « The resident started playing the accordeon. »

Families and caregivers

« Stopping the medication has made a great a huge difference in my spouse. He is more awake and aware of what is happening around him . He is more talkative; howver we do not have always understand what he says! This allows us to have more engaging

• visits. It seems as though he is with us more. »

« It’s great, he is more awake during our visits and it seems like he understands what we say a little better. » « My mother can eat normally now, je peux lui I can bring her food that she likes! » « I can’t get over it, when I arrived my mother recognized me and she called me by my name »

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Questions?

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STRATEGIC FIT

› Leverages strengths in implementation, spread and scale, evaluation and patient engagement › Alignment with federal and shared F/P/T healthcare priorities › Fit with our organizational goals in alignment with our 2019-2021 strategy

IMPACT

› Innovations that drive system-wide, change, specifically:

 Shifting care to home and community  Co-designing care to meet the needs of patients and families  Integrating care to connect services across settings

› Population reach and system values:

 Moving from spread to scale,  On triple aim: patient and family experience of care, quality of life/heaIth outcomes, value for money/appropriate use of resources  Size of population that couId be affected

FEASIBILITY

› Interest from multiple jurisdictions and readiness to receive › Collaborators/partners who are ready to co-design and/or deliver program

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The Appropriate Use Antipsychotics Journey

Incubation Demonstration

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Effectiveness Provincial Spread and Scale