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
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