A recent register-based study examined the impact of Finland’s revised clinical guidelines for the treatment of dementia, published in 2017, on the trend of users of psychotropics in older individuals with dementia in 2009-2020. Conducted on the University of Eastern Finland, the study found that the revised clinical guidelines didn’t reduce using psychotropics within the treatment of behavioral symptoms, despite a suggestion to avoid psychotropics. Nonetheless, there was a slight reduction within the number of latest users of psychotropics.
The findings suggest that the rules were most frequently followed in situations that involved the initiation of a latest medication fairly than in situations involving abandoning an existing one.”
Mervi Rantsi, Researcher, University of Eastern Finland
Effectiveness assessment regarding the implementation of the national clinical guidelines is hampered by the dearth of a control group, and awareness of latest guidelines also tends to spread step by step. Other concurrent societal changes, similar to changes in medication prices or reimbursements, also make it harder to evaluate effectiveness.
In line with the Finland’s revised clinical guidelines for dementia, behavioral symptoms related to dementia should primarily be treated non-pharmacologically, and using psychotropics must be avoided. Effective non-pharmacotherapeutic options include, e.g., changes in health care professionals’ communication to raised accommodate the needs of patients with dementia, in addition to music therapy. The target of Finland’s clinical guidelines for dementia is to disseminate information on evidence-based treatments and to enhance the effectiveness of dementia treatment.
The register-based data included all anti-dementia medication purchases made by Finns 65 years of age or older in 2009-2020 (n= 217 778). Using psychotropics was monitored before and after the publication of the revised clinical guidelines for dementia. In 2009, anti-dementia medications were utilized by 43,750 people in Finland, and 57% of them used no less than one psychotropic. The number of individuals using anti-dementia medications increased in the course of the study. In 2020, anti-dementia medications were utilized by 105,683 people in Finland, and the 52% of them used psychotropics.
The dissemination of evidence-based information, i.e., the implementation of the clinical guidelines, has not been studied at population level in Finland before from the Finnish Prescription Register maintained by the Social Insurance Institution of Finland. Clinical guidelines in other parts of the world, too, recommend avoidance of psychotropics within the treatment of dementia, but research into the consequences of clinical guidelines on using psychotropics stays scarce, with conflicting findings and weak generalisability to the Finnish system.
Published in Age and Ageing, the study was conducted in collaboration between researchers from the University of Eastern Finland and the Finnish Medicines Agency, Fimea. The study constitutes a part of the MEDIFF research project funded by the Social Insurance Institution of Finland. The MEDIFF project evaluates implementation strategies to advertise rational use of medicines in older people.
In line with previous studies and clinical guidelines, individual treatment paths and multi-professional collaboration between health care professionals involved the care of a patient with dementia play a key role in evidence-based treatment of behavioral symptoms.
“Further research is required on the aspects affecting prescription practices and the implementation of pharmacotherapy in accordance with clinical guidelines, in addition to on the provision of non-pharmacological treatment options.”
Source:
University of Eastern Finland (UEF Viestintä)