Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

Abstract

In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (−0.38, 95% confidence intervals (CI) −0.69 to −0.07) and 12 months (−0.47, 95%CI −0.84 to −0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57–5.53) or mortality (relative risk 0.81, 95%CI 0.48–1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement.

The Effect of Regimen Frequency Simplification on Provider Order Generation: A Quasi-Experimental Study in a Korean Hospital

“…In addition, interventions for healthcare professionals could involve repetitive feedbacks and were often dependent on the contents of the intervention in terms of how these professionals received such feedbacks [ 23 , 24 ]. Unlike other studies conducted, interventions on medication simplification by changing direct services delivered by healthcare professionals [ 25 , 26 , 27 , 28 ], we believe that the significance of our study was in its approach to provide a system change. As Schneider et al described, over 95% of health institutions in the United States use the CPOE system [ 29 ]; therefore, our study demonstrating our collaborative approach toward changing the HIS can be instrumental in enhancing this system’s feasibility, serve as a potentially adaptable method to enhance the CPOE system in other healthcare settings, and prove to be a methodological tool for real-world-based intervention studies.…”

Impact of Medication Regimen Simplification on Medication Incidents in Residential Aged Care: SIMPLER Randomized Controlled Trial

“…Neither the time-and-motion study nor the present study investigated the time needed to safely administer different dose forms. However, we have estimated by extrapolating the reduction in average number of administration times at the 4-month follow up across a 100 bed RACF, the intervention would generate savings of 85 h of staff time per month [ 30 ]. This represents time that could be directed to other care, quality, and safety related activities.…”

“…The most frequent recommendations were to change an administration time (65%), formulation (27%), or dose frequency (4%). At four-month follow-up the mean number of medication administration times (the primary outcome) was significantly reduced in the intervention compared to comparison arm (−0.36, 95% confidence intervals (CI) −0.63 to −0.09, p = 0.01) and this was maintained at eight- and 12-month follow-up [ 29 , 30 ]. Although the rate of medication incidents was greater in the intervention arm compared to the comparison arm at four-month follow-up in the unadjusted analyses (incident rate ratio (IRR) 1.91, 95% CI 1.02 to 3.67), no significant difference was observed after adjustment for the rate of medication incidents in the four months pre-study entry (IRR 1.55, 95% CI 0.81 to 2.91, p = 0.17).…”

Process Evaluation of the SImplification of Medications Prescribed to Long-tErm Care Residents (SIMPLER) Cluster Randomized Controlled Trial: A Mixed Methods Study

“…The SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) study was a non-blinded, matched-pair, cluster randomized controlled trial (RCT) of a single multidisciplinary intervention targeting complex medication regimens [ 1 , 3 , 6 , 7 , 8 ]. SIMPLER was the first prospective study to investigate the benefits and harms of medication regimen simplification in RACFs.…”

“…Medication simplification involves consolidating administration times (e.g., by administering medications at the same time, switching to combination products or long-acting formulations) without changing the therapeutic intent of the medication regimen [ 1 , 3 , 9 ]. The SIMPLER study protocol and findings have been described previously [ 1 , 3 , 6 , 7 , 8 ]. In brief, residents at four RACFs were randomized to receive usual care, while those in four matched RACFs received a medication simplification intervention delivered by an experienced clinical pharmacist using the 5-item Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) [ 9 ].…”