A nurse practitioner led protocol to address polypharmacy in long-term care

Bergman-Evans, Brenda

doi:10.1016/j.gerinurse.2020.07.002

Cited by 6 publications

(5 citation statements)

References 55 publications

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“…There are multiple screening tools for physicians to be more mindful of the possibility of adverse effects to PIMs [ 24 ]. Furthermore, in a study with nurse practitioners combatting polypharmacy through medication reviews, the importance of an interprofessional team regarding elderly care was highlighted [ 25 ]. However, further studies are still warranted to determine the optimal method to decrease the prevalence of polypharmacy.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016

et al. 2021

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Background/objectives With an aging population suffering from increased prevalence of chronic conditions in the United States (U.S.), a large portion of these patients are on multiple medications. High-risk medications can increase the risk for drug-drug interactions and medication nonadherence. This study aims to describe the prevalence of polypharmacy and high-risk medication prescribing in U.S. physician offices. Methods This was a cross-sectional study of the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey from 2009 to 2016. All patients over 65 years old were included. Polypharmacy was categorized as no polypharmacy (< 2 medications), minor polypharmacy (2–3 medications), moderate polypharmacy (4–5 medications), and major polypharmacy (>5 medications). Medications were further categorized into high-risk medication categories (anticholinergics, cardiovascular agents, central nervous system (CNS) medications, pain medications, and other). Comparisons between the degrees of polypharmacy were performed utilizing chi-square or Wilcoxon rank-sum tests with JMP Pro 14® (SAS Institute, Cary, NC). Results Over 2 billion patient visits were included. Overall, Polypharmacy was common (65.1%): minor polypharmacy (16.2%), moderate polypharmacy (12.1%), and major polypharmacy (36.8%). Patients with major polypharmacy were older compared to those with moderate or minor polypharmacy (75 vs. 73 years, respectively) and were most frequently prescribed pain medications (477.3 per 1,000 total visits). NSAIDs were the most frequently prescribed, with 232.4 per 1,000 total visits resulting in one high-risk NSAID prescription, while 21.9 per 1,000 total visits resulted in two or more high-risk NSAIDs. Conclusion Most patients over 65 years experienced some degree of polypharmacy, with many experiencing major polypharmacy. This indicates an increased need for expanded pharmacist roles through medication therapy management and safety monitoring in this patient population.

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Section: Discussionmentioning

confidence: 99%

Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016

et al. 2021

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“…We paired survey data by NH provider number and survey year with MDS, which includes detailed health assessments of NH residents (Bergman-Evans, 2020). We included MDS assessments conducted within 90 days of IT maturity survey completion, which was important to capture IT measures nearest to the time the MDS assessments were completed.…”

Section: Methodsmentioning

confidence: 99%

“…We included 816 NHs that completed the survey with at least one regular (i.e., quarterly and annual assessments), MDS assessment in the survey window per survey year, which are not triggered by specific health-related events and thus reduce bias in our analyses (Bergman-Evans, 2020). We removed individuals under the age of 65 at the time of assessment (13% of residents) as their UTI risk differs from the majority of residents (Castle et al, 2017).…”

Section: Methodsmentioning

confidence: 99%

The Association Between Nursing Home Information Technology Maturity and Urinary Tract Infection Among Long-Term Residents

et al. 2022

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Urinary tract infections (UTIs) are the most common infections among nursing home (NH) residents. Antibiotics are often misused when a UTI is suspected. Using sophisticated information technology (IT) could help in appropriate UTI prevention, diagnosis, and treatment. This repeated cross-sectional study explored relationships between IT maturity and UTI prevalence among long-stay NH residents. Data were from (1) four annual surveys 2013–2017 measuring IT maturity in a random sample of Medicare-certified NHs, (2) Minimum Data Set assessments for resident characteristics, and (3) Certification and Survey Provider Enhanced Reporting data for facility characteristics. In multivariate regressions using NH fixed effects, controlling for resident and NH characteristics, Administrative IT maturity in NHs was associated with decreased odds of UTI (AOR: 0.906, 95% CI: 0.843, 0.973). These results were robust in all sensitivity analyses. Using IT to relieve administrative burden may decrease UTIs.

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“…Responsibility for deprescribing has not yet been assigned to a specific healthcare professional and family physicians cite lack of time, fragmentation in care, withdrawal concerns, lack of support, difficulty engaging patients, and uncertainty as barriers to deprescribing [ 3 , 6 – 9 ]. Nurse practitioners (who autonomously diagnose and treat illnesses, order and interpret tests, prescribe medications, and perform medical procedures) [ 10 , 11 ], nurses [ 12 ], general practitioners [ 13 ], and pharmacists [ 14 – 20 ] have been studied as potential supervisors for the deprescribing process. Within interprofessional primary care teams pharmacists bring their knowledge of medications to optimize the management of chronic diseases.…”

Section: Application Of the Seven Essential Components Of Knowledge T...mentioning

confidence: 99%

Implementation of pharmacist-led deprescribing in collaborative primary care settings

et al. 2022

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In many jurisdictions pharmacists share prescribing responsibilities with other members of the primary care team. Responsibility for deprescribing, the healthcare professional supervised withdrawal of medications that are no longer needed, has not been assumed by a specific member of the primary care team. In this commentary we describe implementation of pharmacist-led deprescribing in collaborative primary care settings using the seven components of knowledge translation. Patient and stakeholder engagement shaped the deprescribing intervention. The intervention was implemented in three collaborative primary care clinics in two Canadian provinces. The evaluation included measures of medication appropriateness, patient satisfaction, and healthcare professional satisfaction. Pharmacist-led deprescribing in primary care was acceptable to both patients and healthcare professionals and demonstrated a reduction of medications deemed to confer more risk than benefit. Our findings support successes in pharmacist-led deprescribing. Future work is needed to understand how to successfully implement and evaluate pharmacist-led deprescribing more widely.

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A nurse practitioner led protocol to address polypharmacy in long-term care

Cited by 6 publications

References 55 publications

Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016

Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016

The Association Between Nursing Home Information Technology Maturity and Urinary Tract Infection Among Long-Term Residents

Implementation of pharmacist-led deprescribing in collaborative primary care settings

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