The study reported by Patterson and colleagues22 provides the most robust evidence of the effectiveness of this approach to reducing inappropriate prescribing. The intervention used was also the most sophisticated and used an element of in-reach as well as medication review, with specially trained pharmacists visiting intervention homes monthly for

12 months to review prescribing information and guide prescribing decisions. The authors reported a significant difference between intervention selleck kinase inhibitor and control homes in the proportion of residents taking inappropriate antipsychotic medications (20% vs 50% [odds ratio = 0.26; 95% confidence interval 0.14–0.49]). The design of the remaining 3 studies permits the consideration of trends selleck compound in results only. Two used audit and feedback and reminders to review medication needs on a regular basis33 and 34 and these resulted in minimal changes in prescribing rates. The final study was conducted against a background of changes in accommodation conditions for the residents such that they were moved into a specialized, secure dementia unit. Perhaps unsurprisingly, prescription rates were reduced from the extremely high (95% of residents receiving antipsychotic medication) to a much lower proportion

(58%), although it is not possible to determine whether this was due to the change in accommodation or the intervention. The 5 studies using multicomponent interventions ranged in complexity from a study involving 3 components, audit and feedback, continuity of care, and change to the site of service delivery36 to 7 components incorporating education, audit and feedback, and structural

changes.27 and 28 Studies also varied widely in size, and were implemented in between 1 and 25 homes. All studies showed reductions in prescription rates (ranging from 5% to 66%) associated with the intervention, although only the study reported by Westbury and colleagues was controlled.27 and 28 Only 4 studies assessed whether changes Parvulin to prescription levels achieved during the intervention period were maintained. Two studies reported a return to baseline antipsychotic prescription levels.27, 28 and 29 Testad and colleagues18 reported that medication levels remained constant 6 months after the end of the intervention. Finally, Rovner and colleagues39 reassessed psychotropic drug use 9 months after the end of the study period and found the effects in the intervention on prescription rates had been maintained. Detail is sparse because these follow-up visits were outside of the formal trial period, but it is likely that the extent to which procedures used during the study continued to be used varied between sites both within the same trial and between trials.