The health professional experience of using antipsychotic medication for dementia in care homes: A study using grounded theory and focussing on inappropriate prescribing

Introduction Treating the behavioural and psychological symptoms of dementia with antipsychotics can cause detrimental side-effects but their use in care homes remains problematic with the views of professionals not fully explored. Aim/questionTo develop an in-depth explanatory model about inappropriate prescribing of antipsychotics in dementia within care homes. MethodsTwenty-eight participants from eight different professional groups with a role in shaping treatment decisions in dementia care were recruited and interviewed. The audio-recorded interviews were transcribed and analyzed using constructivist grounded theory. ResultsWhen patients with dementia present with behavioural and psychological symptoms, the prescribing of antipsychotics allows the multitude of work in a care home to be managed; the effectiveness of antipsychotics is more perceptible than their side-effects. This perceived usefulness strengthens beliefs that these medications ought to be prescribed again in future situations, generating a self-fulfilling prophecy. DiscussionOur findings may partly explain why the launch of the national dementia strategy in England has been found not to have reduced antipsychotic prescribing in care homes. Implications for practicePositive perceptions based on past experiences with antipsychotics should be challenged through future interventions that tackle inappropriate prescribing, for example using behaviour change techniques to better highlight adverse consequences of prescribing.