The national AMI Alzheimer programme in France

The national AMI Alzheimer programme in France:  a powerful tool for risk measurement & risk reduction

Risk Measurement: the French national survey

The French National Authority for Health created a national task force which sought to establish and monitor the rate of exposure to antipsychotics (AP) and other psychotropic drugs (PD) in people living with Alzheimer disease (AD) in France, as an alert indicator.

ALERT indicator = Rate of ADs with prescription of AP

Numerator

Number of people living with Alzheimer's disease with a prescription of antipsychotics

Any prescription of antipsychotics constitutes an alert.

The list of antipsychotics is provided in Annex 2

Denominator

Number of people living with Alzheimer's disease

Data

Measurement performed retrospectively.

The alert can be measured by the prescriber, the pharmacist, the nurse or any member of the multidisciplinary care team.

People living with Alzheimer's disease may be identified in several ways:

  • From the diagnosis: analysis of the medical record (clinical diagnosis of Alzheimer disease and other forms of dementia)
  • From the specific Alzheimer disease treatment and/or the specific insurance covering long-term care (ALD15): Analysis of the prescription or medical record (prescription history) – Use of the prescribing, dispensing or healthcare software.

 

Assessing the changes in practices relies on the alert indicator on the exposure of persons living with Alzheimer's disease to APs (National health institutions, Public Insurances & HAS collaboration).

The measurement of long-term APs and psychotropics prescriptions was performed using the 3 national insurance databases from 2007 to 2010, for people over 65 (n= 9,984,693 in 2007; n= 10,609,439 in 2010) and for people over 65 living with AD identified by coverage for specific treatments and chronic conditions (n= 385,070 in 2007; 437,583 in 2010). Three age categories were studied: 65-74; 75-84 and 85+. The lists of AP and PD were defined by the task force and updated each year.

 

Risk Reduction: the French national AMI Alzheimer programme

In conjunction with the national task force composed of health professionals and the other institutions, the French National Authority for Health has developed, within the framework of the French Alzheimer Plan, the programme:  Alert and Mastering of Iatrogenicity (AMI) of APs in Alzheimer's disease.

The objective of the programme AMI-Alzheimer is to reduce the inappropriate use of APs and to improve care for behavioural disturbances in dementia, while having recourse to other alternative treatments (for example:  new care techniques) without deferring to other sedatives or physical restraints. 

This indicator has been implemented by various institutions:  e.g. the French Alzheimer Plan uses it as a quality of life indicator; regional health agencies use it as a follow-up indicator for the national plan. It is also used for example, as a quality indicator for the evaluation of Homes for the Autonomy and Integration of Persons living with Alzheimer's Disease, as an indicator for the health insurance risk management programme in homes for dependent elderly persons (EHPAD) and is one of the 15 quality indicators used by the National Agency for the evaluation of the quality of establishments and social and medical-social services for EHPAD self-assessment.

Dissemination of the AMI Alzheimer programme to all of the healthcare actors should provide for a common alert measurement at the national level (macro), but also at the regional (meso) and local levels. The only way to reduce the national alert indicator is through local alert/mastering actions led by care teams and prescribers.

 

MASTERING indicator = Rate of ADs with continuous or repeated prescription of AP, confirmed and justified among the ADs with prescription of AP

Numerator

Number of people living with Alzheimer's disease with an AP prescription whose prescription was confirmed by the prescriber (appropriate prescription) with justification (benefit-risk balance) noted and justified in the record.

This number evolves progressively as the prescriptions are reviewed

Denominator

Number of people living with Alzheimer's disease on AP

This number evolves progressively  as the prescriptions are reviewed and some AD stop taking AP

Data

Measurement performed prospectively and dynamically

Mastery is measured by the prescriber or is referred to the multidisciplinary team by the prescriber according to the choices made when the AMI clinical practice indicators were set up.

 

Results: reduction of the national rate of APs exposure in persons living with AD

The French national measurement showed that Alzheimer's patients and, in particular younger patients living with AD, are overexposed to psychotropics and particularly to APs: In 2007, persons living with AD had an exposure rate to APs which was 5.8 times higher (16.9%) than that of the general elderly population (2.9%). Exposure in younger AD patients (aged 65-74) was even higher (19%). The rate of AP exposure in persons with AD decreased from 16.9% in 2007 to 15.5% in 2010, with a similar trend observed in the three age categories and in the three different insurance databases. These results advocate for a dedicated safety policy to reduce these avoidable, iatrogenic risks in this fragile population.

 

Contact persons: Dr Armelle Leperre-Desplanques This email address is being protected from spambots. You need JavaScript enabled to view it. ,  Carole Micheneau This email address is being protected from spambots. You need JavaScript enabled to view it.

References

Overuse of antipsychotics and other psychotropic's in Alzheimer's patients: the results of 4 year French national survey. 29th International Conference of Quality & Safety in Health Care (ISQUA), Geneva :

C8-2215 Abstract

Oral presentation

The Alert & Mastering of Iatrogenicity of antipsychotics indicator in people living with Alzheimer disease

ALCOVE synthesis report, chapter Epidemiological data in Dementia & Workforce-Skills in chapter Support systems for BPSD

Brochure – AMI AL Programme

The national AMI ALZHEIMER TOOLS for risk reduction in France

  • AMI (Alert & Mastering of Iatrogenicity) indicator 1- Antipsychotics in the person living with dementia
  • Where is the AMI Alzheimer programme being implemented?
  • How is the AMI Alzheimer programme implemented?
  • Management of behavioural problems in Alzheimer's and related diseases
  • Tools for measuring detection and control indicators
  • Non-drug therapies in the management of behavioural problems
  • Nursing home (EHPAD)
  • Health care networks for the elderly
  • Health care facilities: short, medium & long term stays

http://www.has-sante.fr/portail/jcms/c_1055540/alzheimer-s-disease-and-iatrogenicity-of-antipsychotics