Changing the Culture of Prescribing in Ontario Nursing Homes

July 14, 2016

​By: Jennifer Lee, Senior Health Policy Communications Specialist, Women's College Hospital Institute for Health System Solutions and Virtual Care

Ontario has some of the highest anti-psychotic prescribing rates in Canada and for seniors that means an increased risk of falls and hospitalizations. It's been in the news, it's been the subject of a report released by Health Quality Ontario (HQO), it's been the focus of a Ministry of Health and Long-Term Care (Ministry) working group. But what can we do about it?

Researchers based at the Women's College Hospital (WCH) Institute for Health System Solutions and Virtual Care (WIHV) suggest that educating professionals who work in nursing homes and giving them feedback on how their practices compare to others could change the game. They are acting as lead evaluators on a provincial demonstration project involving HQO, the Ontario Medical Association (OMA) and the Ministry.

Dr. Laura Desveaux and Dr. Noah Ivers are putting this new concept to the test in a clinical trial that looks at strategies to improve prescribing at 60 nursing homes across the province. In this study, prescribers will receive confidential practice reports that show them how their practice trends stack up against providers in other parts of the province and will be able to view things like clinical and demographic characteristics of their patients. Some of the nursing home staff will also receive carefully crafted outreach support and education from trained healthcare professionals.

The evaluation team will determine whether this kind of support is a cost-effective way to improve quality in healthcare. They will also look at other complexities behind current prescribing practices, like barriers to change, if and how certain interventions can improve clinician knowledge or even motivate change. Looking at the big picture impacts, the study will also weigh the effectiveness of certain interventions against costs and savings to the healthcare system that result from things like fewer falls and visits to the emergency room.

So far, researchers have learned that nursing homes have unique needs and appreciate a more customized approaches change. By shifting the focus from political issues to clinical problems that affect seniors, prescribers and clinicians in nursing homes are now starting to look forward to positive and lasting changes that will help their patients.

Early results from this study will be reviewed by the OMA and the Ministry this fall. When final results are out, they are expected to throw a lot of weight behind a new approach to improving safety for prescribing to seniors that can be scaled up across the province.

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