The Practice Improvement in Education (PIE) Project: Patient Outcome Related to Education on Depression in Nursing Homes

Sung Eun Jang; Wen, Aida; Bell, Christina; Parkins, Sebrina; Jan Shishido; Masaki, Kamal
September 2015
Hawaii Journal of Medicine & Public Health;2015 Supplement, Vol. 74, p39
Academic Journal
Background: Depression is an important factor related to agitation and other behaviors in nursing home residents. As the next step in our Geriatric Education Center (GEC) Practice Improvement in Education (PIE) project on depression in nursing homes, we focused on non-pharmacologic behavioral management and psychoactive medication reduction. Methods: This quality improvement (QI) pilot included training on effective interdisciplinary management approaches for depressive symptoms and challenging behaviors, and implementing an adapted ABC (antecedents, behaviors, consequences) log and behavioral activation. We targeted two nursing home floors and included data on residents present both before and after the QI, in June 2013 and July 2014. We examined changes in depressive symptom scores (Patient Health Questionnaire, or PHQ-9, scale 0-27, higher=worse) and antipsychotic/antidepressant medication use with paired T-tests and Fisher's exact tests. Results: Of the 66 nursing home residents in this QI pilot, 70% were female, 60.6% were > 89 years old (range = 48-108, mean = 88.8), 83% were Asian and 51% had severe cognitive impairment. Mean PHQ-9 scores decreased significantly from 3.74 to 2.38 (P = .017). Of the 13/66 (19.7%) residents on antipsychotic medications, 10/13 (76.9%) had dose reductions and 4/13 (30.8%) had medications completely discontinued (P < .0001 for change pre/post). Of the 34 (51.5%) residents on antidepressant medication, 15/34 (42.9%) had dose reductions and 3/34 (8.8%) had medications completely discontinued (P < .0001 for change pre/post). Conclusion: Mean depression scores and antipsychotic and antidepressant medication use decreased significantly in this GEC PIE QI project to manage depression and behaviors non-pharmacologically in nursing home residents.


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