Discontinuing Inappropriate Medication Use in Nursing Home Residents

Wouters, Hans; Scheper, Jessica; Koning, H.M.; Brouwer, Chris; Twisk, Jos W. R.; Meer, Helene G van der; Boersma, Froukje; Zuidema, Sytse U.; Taxis, Katja

doi:10.7326/m16-2729

Cited by 81 publications

(117 citation statements)

References 34 publications

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“…Other structured deprescribing methods have recently been evaluated in very frail older people using a randomized controlled trial design, and they also reported statistically significant reductions in potentially inappropriate prescriptions. Potter et al 29 used an implicit (ie, judgment-based) algorithm that requires the user to answer a series of questions about each drug in the patient's regimen; Wouters et al 30…”

Section: Discussionmentioning

confidence: 99%

Deprescribing in Older People Approaching End of Life: A Randomized Controlled Trial Using STOPPFrail Criteria

Curtin

Jennings

Daunt

et al. 2019

J American Geriatrics Society

148

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OBJECTIVES Older people approaching end of life are commonly prescribed multiple medications, many of which may be inappropriate or futile. Our objective was to examine the effect of applying the STOPPFrail, a recently developed deprescribing tool, to the medication regimens of older patients with advanced frailty. DESIGN Randomized controlled trial. SETTING Two acute hospitals in Ireland. PARTICIPANTS Adults 75 years or older (n = 130) with advanced frailty and polypharmacy (five or more drugs), transferring to long‐term nursing home care. INTERVENTION A STOPPFrail‐guided deprescribing plan was presented to attending physicians who judged whether or not to implement recommended medication changes. MEASUREMENTS The primary outcome was the change in the number of regular medications at 3 months. Secondary outcomes included unscheduled hospital presentations, falls, quality of life, monthly medication costs, and mortality. RESULTS Intervention (n = 65) and control group (n = 65) participants were prescribed a mean (plus or minus standard deviation [SD]) of 11.5 (±3.0) and 10.9 (±3.5) medications, respectively, at baseline. The mean (SD) change in the number of medications at 3 months was −2.6 (±2.73) in the intervention group and −.36 (±2.60) in the control group (mean difference = 2.25 ± .54; 95% confidence interval [CI] = 1.18‐3.32; P < .001). The mean change in monthly medication cost was –$74.97 (±$148.32) in the intervention group and –$13.22 (±$110.40) in the control group (mean difference $61.74 ± $26.60; 95% CI = 8.95‐114.53; P = .02). No significant differences were found between groups for any of the other secondary outcomes. CONCLUSION STOPPFrail‐guided deprescribing significantly reduced polypharmacy and medication costs in frail older people. No significant differences between groups were observed with regard to falls, hospital presentations, quality of life, and mortality, although the trial was likely underpowered to detect differences in these outcomes. J Am Geriatr Soc 68:762–769, 2020

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Section: Discussionmentioning

confidence: 99%

Deprescribing in Older People Approaching End of Life: A Randomized Controlled Trial Using STOPPFrail Criteria

Curtin

Jennings

Daunt

et al. 2019

J American Geriatrics Society

148

View full text Add to dashboard Cite

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“…In a Dutch cluster randomized trial to discontinue inappropriate medications, physicians in collaboration with pharmacists performed one multidisciplinary, multistep medication review for NH residents [48]. After a mean follow-up of 144 days, at least one inappropriate medication (according to the STOPP criteria [49]) was discontinued for 39% of participants, as compared to 29.5% in the control group, for an adjusted relative risk of 1.23 (95% CI 1.02–1.75), while there was no deterioration of clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study

Wilchesky

Muêller²,

Morin

et al. 2018

BMC Geriatr

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BackgroundMedication regimens in nursing home (NH) residents with severe dementia should be frequently reviewed to avoid inappropriate medication, overtreatment and adverse drug events, within a comfort care approach. This study aimed at testing the feasibility of an interdisciplinary knowledge exchange (KE) intervention using a medication review guidance tool categorizing medications as either “generally”, “sometimes” or “exceptionally” appropriate for NH residents with severe dementia.MethodsA quasi-experimental feasibility pilot study with 44 participating residents aged 65 years or over with severe dementia was carried out in three NH in Quebec City, Canada. The intervention comprised an information leaflet for residents’ families, a 90-min KE session for NH general practitioners (GP), pharmacists and nurses focusing on the medication review guidance tool, a medication review by the pharmacists for participating residents with ensuing team discussion on medication changes, and a post-intervention KE session to obtain feedback from team staff. Medication regimens and levels of pain and of agitation of the participants were evaluated at baseline and at 4 months post-intervention. A questionnaire for team staff explored perceived barriers and facilitators. Statistical differences in measures comparing pre and post-intervention were assessed using paired t-tests and Cochran’s-Q tests.ResultsThe KE sessions reached 34 NH team staff (5 GP, 4 pharmacists, 6 heads of care unit and 19 staff nurses). Forty-four residents participated in the study and were followed for a mean of 104 days. The total number of regular medications was 372 pre and 327 post-intervention. The mean number of regular medications per resident was 7.86 pre and 6.81 post-intervention. The odds ratios estimating the risks of using any regular medication or a “sometimes appropriate” medication post-intervention were 0.81 (95% CI: 0.71–0.92) and 0.83 (95% CI: 0.74–0.94), respectively.ConclusionA simple KE intervention using a medication review guidance tool categorizing medications as being either “generally”, “sometimes” or “exceptionally” appropriate in severe dementia was well received and accompanied by an overall reduction in medication use by NH residents with severe dementia. Levels of agitation were unaffected and there was no clinically significant changes in levels of pain. Staff feedback provided opportunities to improve the intervention.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0895-z) contains supplementary material, which is available to authorized users.

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“…The goal of this study was to investigate the effectiveness of a single medication review performed by physicians in collaboration with pharmacists 4. This process included an assessment of the patient perspective, medical history, critical appraisal of medications, a meeting between the treating physician and pharmacist and the implementation of medication changes.…”

Section: Methodsmentioning

confidence: 99%