Grant: Meetings, Planning and Dissemination Grant: Health Services and Policy Research

A key component of any large-scale effort to improve prescribing practices in LTC homes is the ability to measure and report on the quality of drug prescription. This is an important first step towards quality improvement. Public reporting of quality measures for LTC residents has begun in many provinces and continues to expand across Canada. Our goal for a CIHR-IHSPR Meetings, Planning and Dissemination Grant, is to organize a modified Delphi consensus panel focused on improving existing measures of prescribing quality in LTC. Specifically, we will focus our attention on benzodiazepines (a class of psychoactive medications that are commonly prescribed in the LTC setting for anxiety and sleep disorders). Patient safety is a concern with these medications as they are associated with serious adverse events including risk of falls, patient confusion and dependence. Current measures of prescribing quality often do not integrate the clinical context of prescribing decisions and/or the fact that LTC residents undergo multiple care transitions (e.g., community to LTC facility to emergency department to hospital to LTC facility). As well, with current measures the individual facility (or prescriber) lacks the ability to take ownership for the original prescription decision thereby foregoing a direct linkage to quality improvement initiatives. Through the structured panel process, we will: 1) identify important processes of care (based on transition points and specific clinical conditions) which might influence prescribing decisions related to benzodiazepines and subsequent drug-related outcomes; 2) identify measures that might be used to assess these process-outcome links. We plan to transfer the knowledge generated during this process through our partnerships with health quality councils from Ontario and Saskatchewan. Our findings will inform the selection of indicators of prescribing quality in future provincial reports.