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

Accelerating the Spread and Scale of Innovations in Healthcare Tanya Mac Donald April 15 2019 cfhi-fcass.ca | @cfhi_fcass.ca

Disclosure I have no actual or potential conflict of interest in relation to this topic or presentation. cfhi-fcass.ca | @cfhi_fcass.ca 2

cfhi-fcass.ca | @cfhi_fcass.ca 3

OUR GOALS & OBJECTIVES cfhi-fcass.ca | @cfhi_fcass.ca 4

Appropriate Use of Antipsychotics in Long Term Care

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. cfhi-fcass.ca | @cfhi_fcass.ca 7

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. 8

Provincial Scale Collaboratives cfhi-fcass.ca | @cfhi_fcass.ca 9

How? Measurement Tools and Seed Funding Resources Provincial Partnership Implementation Peer to Peer support Exchange Training cfhi-fcass.ca | @cfhi_fcass.ca 10

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 cfhi-fcass.ca | @cfhi_fcass.ca 11

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) cfhi-fcass.ca | @cfhi_fcass.ca 12

Value for Money/Appropriateness of 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. cfhi-fcass.ca | @cfhi_fcass.ca 13

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. cfhi-fcass.ca | @cfhi_fcass.ca 14

« It’s great, he is more awake during our visits and it seems like he understands what we say a little better. » Families and « The resident started playing the accordeon. » caregivers « 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 » « 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. » « I am less aggressive and I can move better. I can also eat and drink better. »

Questions? cfhi-fcass.ca | @cfhi_fcass.ca 16

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 cfhi-fcass.ca | @cfhi_fcass.ca 17

The Appropriate Use Antipsychotics Journey Provincial Spread and Demonstration Scale of Incubation Effectiveness cfhi-fcass.ca | @cfhi_fcass.ca 18