Antipsychotics (AP) are frequently used in Quebec long-term care centres (LCT), especially in older residents with major neurocognitive disorders (MNCD), and behavioural and psychological symptoms of dementia (BPSD), with prevalence up to 50%. There are issues related to the prescription of APs: They are associated with adverse health events, high costs and poor quality of life; their appropriateness is often questioned because due to poor efficacy and safety concerns. Their high prevalence is an indicator of suboptimal care. In 2017, the Quebec Health and Social Services Ministry in partnership with the Canadian Foundation for Healthcare Improvement launched the pilot phase of OPUSAP in 24 LTC with the overall objective to 1) Improve the appropriateness of AP use in older residents with MNCD and BPSD and 2) Prioritize the use of non-pharmacological interventions. OPUS-AP is a conference and webinar-based training (integrated knowledge) program designed to mentor healthcare personnel (i.e., physicians, pharmacologists, nurses, physiotherapists, orderlies) which has been designed to: 1) Improve knowledge on the optimal use of AP, 2) Provide guidelines on AP deprescribing, and use of patient-centred care and non-pharmacological interventions to treat BPSD. OPUS-AP is a solution designed to develop standardized and objective best practices using a structured online assessment with recurring assessments of health condition and AP prescription in LTC residents, as well as of the occurrence of adverse health events including falls, admission in acute care and death. OPUS-AP is an epidemiologic method of monitoring of the evolution of AP prescription and health condition in older residents living in LTC, and changes in professional practices.

• To examine the effects of OPUS-AP on changes in AP prescription, health condition and use of non-pharmacological interventions in older LTC residents with MNCD and BPSD
• To perform a qualitative analysis of the implementation of OPUS-AP in LTC staff daily practice

The design is a longitudinal, prospective, multicentre cohort study designed with repetitive measures. Quantitative and qualitative variables are recorded.

OPUS-AP is composed of two consecutive phases: A pilot phase in 24 LTC facilities, followed by an extension phase to 136 LTC centres which will include around 3,000 residents in total.

To improve clinical practices, in particular the deprescribing of APs by staff working in longterm care centres

To support changes to best practices for the prescription of APs through adequate training methods and standardized follow-up assessments

To develop the OPUSAP online platform, which is a specific tool built for spreading OPUS-AP program knowledge and maintaining thusly acquired skills

CIUSSS Estrie CHUSs, CISSSs and CIUSSSs of Quebec

Ministry of Health and Social Services

Canadian Foundation for Healthcare Improvement (CFHI)

National Institute of Excellence in Health and Social Services

Regroupement provincial des comités des usagers

Quebec Federation of Alzheimer Societies