Development of a tool for monitoring the prescribing of antipsychotic medications to people with dementia in general practice: a modified eDelphi consensus study

Figures & data

Table 1 Participants by professional group

	Initially recruited	Participation in round 1	Participation in round 2
GPs	8	8	7
Psychiatrists	4	4	2
Geriatricians	2	2	2

Abbreviation: GPs, general practitioners.

Table 2 Statements that were accepted, rejected and re-rated at each stage

	Number of statements	Statements to be included	Statements excluded	Statements to be re-rated	New statements added
Round 1	21	11	1	9	2
Round 2	11	9	2	2a	0

Note:

a Two statements brought to research steering group for discussion were ultimately rejected.

Table 3 Round 1 statements with their associated consensus decisions

Statement	Agreement rating (%)	Outcome
A repeat prescribing monitoring template for antipsychotic (AP) use in patients with dementia should include personal details including name, date of birth and patient identification number	92.8	Endorsed
A repeat prescribing monitoring template for AP use in patients with dementia should include clearly stated medical diagnosis	92.8	Endorsed
A repeat prescribing monitoring template for AP use in patients with dementia should include the name, dose and duration of AP drug prescribed	92.8	Endorsed
A repeat prescribing monitoring template for AP use in patients with dementia should include whether or not additional PRN (as required) APs were used during the period of AP prescription	100	Endorsed
Medical review prior to initiation of APs for patients with dementia should include documented consent from patient with dementia/patient’s next of kin prior to initiation of drug therapy	28.5	Rejected
Medical review prior to initiation of APs for patients with dementia should include trial of non-pharmacological treatment options prior to initiation of AP drug therapy	92.8	Endorsed
Prior to initiation of AP drug therapy by GPs, in patients with dementia, the following should be checked and documented
1. Baseline FBC	78.5	No consensus
2. Baseline LFTs	64.2	No consensus
3. Baseline TFTs	78.5	No consensus
4. Baseline U&Es	78.5	No consensus
5. Baseline BMI	64.2	No consensus
6. Baseline ECG	78.5	No consensus
Adverse drug reactions – GPs should document improvements/disimprovements in BPSD following a period of AP use	100	Endorsed
The presence/absence of the following medication side effects should be documented prior to repeat prescribing of APs in patients with dementia:
1. Increase in BMI	71.4	No consensus
2. Cardiovascular disease/worsening of condition in patients with preexisting cardiovascular disease	78.5	No consensus
3. Sedation	100	Endorsed
4. Extrapyramidal symptoms/impaired mobility	100	Endorsed
5. Confusion	92.8	Endorsed
Regarding review of AP prescription for patients with dementia:
1. Patients with dementia who are prescribed AP drugs in the community for the first time should have a documented review by their GP at 6 weeks	85.7	Divided opinion in qualitative feedback
2. Following the initial 6-week review, patients with dementia on AP therapy should have documented review by their GP at least 3 monthly thereafter	85.7	Endorsed
3. Medical reasons for continuation/discontinuation of the drug should be documented by the GP at each review	85.7	Endorsed

Abbreviations: AP, antipsychotic; BMI, body mass index; ECG, electrocardiograph; FBC, full blood count; GP, general practitioner; LFTs, liver function tests; TFTs, thyroid function tests; U&Es, urea and electrolytes.

Table 4 Round 2 statements with their associated consensus decisions

Statement	Agreement rating (%)	Outcome
Prior to initiation of AP therapy by GPs in patients with dementia, the following should be checked:
1. FBC	90.9	Endorsed
2. LFTs	90.9	Endorsed
3. TFTs	90.9	Endorsed
4. U&Es	81.8	Endorsed
5. BMI	50	Rejected
6. ECG	72.7	Endorsed
7. Urinalysis	50	Rejected
Where feasible, the presence/absence of the following medication side effects should be documented prior to repeat prescribing of APs in patients with dementia:
1. Increase in BMI	54	Brought for discussion in the research steering group
2. Cardiovascular disease/worsening of condition in patients with preexisting cardiovascular disease	72.7	Endorsed
In a monitoring template for repeat prescribing of APs in patients with dementia:
1. Patients with dementia who are prescribed AP drugs for the first time should have a documented review by their GPs within 6 weeks	72.7	Endorsed
2. Following initial review, patients with dementia on repeat prescribed that AP therapy should have a documented review by their GPs at least 3 monthly thereafter	72.7	Endorsed
3. Medical reasons for continuation/discontinuation of the drug should be documented by the GPs at each review	81.8	Endorsed
4. Patients with dementia who are prescribed AP drugs for the first time should have a documented review by their GPs within 4 weeks	54.5	Brought for discussion in the research steering group

Abbreviations: AP, antipsychotic; BMI, body mass index; ECG, electrocardiograph; FBC, full blood count; GP, general practitioner; LFTs, liver function tests; TFTs, thyroid function tests; U&Es, urea and electrolytes.

Figure S1 The finalized monitoring tool for repeat prescription of antipsychotic mediation.