Implementing antipsychotic reduction in long-term care: interdisciplinary and lived-experience insights into...

Despite the availability of evidence-based antipsychotic reduction strategies, implementation of these strategies in long-term care (LTC) often stalls. Understanding how change occurs in real-world practice requires perspectives from interdisciplinary team members. This study interviewed interdisciplinary team members, a family caregiver, and a person living with dementia in LTC in Vancouver, Canada, to explore how they operationalize antipsychotic reduction in LTC homes and examine their perceived barriers and facilitators to implementation.

Semi-structured interviews were conducted with 20 participants: 18 interdisciplinary healthcare providers, one dementia advocate, and one family caregiver. Data were analyzed using reflexive thematic analysis. To preserve inductive insights, the Consolidated Framework for Implementation Research (CFIR) was applied post hoc to the emergent themes. We examined the extent to which the findings were aligned with the CFIR, thereby deepening the analysis.

Identified strategies included person-centered care planning, non-pharmacological interventions, medication review with behavior monitoring, and education. Barriers were: (1) challenging work environments, (2) safety concerns and unconscious dismissive attitudes, and (3) communication gaps. Facilitators included: (1) supportive leadership and frontline champions, (2) team communication, and (3) persistence. Each factor aligns with different CFIR constructs and domains to varying degrees.

The main contribution of this study is that, drawing on CFIR, it found barriers to antipsychotic reduction in LTC are not merely individual but also systemic. Sustained improvement depends on policies that enable and resource effective interdisciplinary teamwork. This includes adequate staffing, education, team communication, and culture change.