Interventions to improve suboptimal prescribing in nursing homes: A narrative review

Marcum, Zachary A.; Handler, Steven M.; Wright, Rollin M.; Hanlon, Joseph T.

doi:10.1016/j.amjopharm.2010.05.004

Cited by 57 publications

(38 citation statements)

References 38 publications

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“…9,25,26 A limited number of Our results are consistent with 2 randomized controlled trials published since the start of the OPTI-SCRIPT study in finding a multifaceted intervention to be effective. 13,14 In the Rx-PAD study, Rognstad et al 14 and Straand et al 29 found peer academic detailing, delivered at continuing medical education meetings, with mailed prescriber feedback, produced a 10% (95% CI, 5.9%-15.0%) reduction in PIP.…”

Section: Main Findingssupporting

confidence: 76%

“…No single interventional strategy has proved to be most effective. 9 A number of commentators have argued that a multifaceted intervention, which combines a number of techniques within a single intervention, 10 may be more likely to improve prescribing than any one intervention alone. 11,12 To date, a limited number of multifaceted interventions have been evaluated in primary care to decrease PIP.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

Clyne

Smith

Hughes³

et al. 2015

The Annals of Family Medicine

152

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PURPOSE Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescribing for Older People in Primary Care, a cluster-randomized controlled trial) tested the effectiveness of a multifaceted intervention for reducing PIP in primary care. METHODSWe conducted a cluster-randomized controlled trial among 21 general practitioner practices and 196 patients with PIP. Intervention participants received a complex, multifaceted intervention incorporating academic detailing; review of medicines with web-based pharmaceutical treatment algorithms that provide recommended alternative-treatment options; and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions. We performed intention-to-treat analysis using random-effects regression.RESULTS All 21 practices and 190 patients were followed. At intervention completion, patients in the intervention group had significantly lower odds of having PIP than patients in the control group (adjusted odds ratio = 0.32; 95% CI, 0.15-0.70; P = .02). The mean number of PIP drugs in the intervention group was 0.70, compared with 1.18 in the control group (P = .02). The intervention group was almost one-third less likely than the control group to have PIP drugs at intervention completion, but this difference was not significant (incidence rate ratio = 0.71; 95% CI, 0.50-1.02; P = .49). The intervention was effective in reducing proton pump inhibitor prescribing (adjusted odds ratio = 0.30; 95% CI, 0.14-0.68; P = .04). CONCLUSIONSThe OPTI-SCRIPT intervention incorporating academic detailing with a pharmacist, and a review of medicines with web-based pharmaceutical treatment algorithms, was effective in reducing PIP, particularly in modifying prescribing of proton pump inhibitors, the most commonly occurring PIP drugs nationally.

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Section: Main Findingssupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

Clyne

Smith

Hughes³

et al. 2015

The Annals of Family Medicine

152

View full text Add to dashboard Cite

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“…46 A systematic review of the implementation of psychosocial interventions for people with dementia in care homes found that active engagement of care-home staff and family members played a crucial role in successful implementation. 47 Similarly, systematic reviews on the more general topic of improving prescribing practice in care homes 48e53 also have been unable to make clear recommendations for future practice due to the varied nature of the design, interventions, outcomes, and results 49,50,53 and the poor quality of included studies. 48,51,52 …”

Section: Results In Contextmentioning

confidence: 98%

Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications in People With Dementia Resident in Care Homes: A Systematic Review

Thompson-Coon

Abbott

Rogers

et al. 2014

Journal of the American Medical Directors Association

118

116

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“…These reviews generally concluded that the available evidence is mixed concerning the impact of interventions by pharmacists in the nursing home setting. [29,31,[33][34][35] …”

Section: Role and Impact Of The Pharmacist In The Nursing Home Settingmentioning

confidence: 98%

The Role of the Pharmacist in Optimizing Pharmacotherapy in Older People

2012

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Prescription of medicines is a fundamental component of the care of older people, but evidence suggests that pharmacotherapy in this population is often inappropriate. Pharmacists have been involved in different approaches for the optimization of prescribing and rational medication use in older people. This article describes the different models of care in which pharmacists are involved in the optimization of pharmacotherapy in older people, and reviews the impact of these approaches on both process and outcome measures. The provision of pharmaceutical care, medication reviews and educational interventions by pharmacists in the nursing home, ambulatory and acute care settings are discussed. We selected systematic reviews, reviews and original studies, and for the latter, we focused more specifically on European publications published between 2001 and 2011. From the literature reviewed, it is clear that when pharmacists play a proactive role in performing medication reviews and in the active education of other healthcare professionals, pharmacotherapy for older patients is improved. However, the evidence of the impact of pharmacists' interventions on health outcomes, quality of life or cost effectiveness of care is mixed. Better results have been reported when pharmacists are skilled and work in the context of a multidisciplinary team. Opportunities remain for multicentre, European-based, pharmacist-intervention trials in all settings, to determine the effectiveness and economic benefit of pharmacist involvement in the optimization of pharmacotherapy in older people.

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Interventions to improve suboptimal prescribing in nursing homes: A narrative review

Abstract: Background-Appropriate medication prescribing for nursing home residents remains a challenge.

Cited by 57 publications

References 38 publications

Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications in People With Dementia Resident in Care Homes: A Systematic Review

The Role of the Pharmacist in Optimizing Pharmacotherapy in Older People

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