Randomized controlled intervention in cardiovascular drug treatment in nursing homes

Ulfvarson, Johanna; Adami, Johanna; Ullman, Bengt; Wredling, Regina; Reilly, Marie

doi:10.1002/pds.855

Cited by 13 publications

(10 citation statements)

References 14 publications

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“…A similar finding was reported by Ulfvarsson et al , where advice on changes in prescribing was followed by a prescription change in 48% of cases 29. There are a number of possible explanations for these low figures.…”

Section: Discussionsupporting

confidence: 84%

Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial

Bladh

Ottosson²,

Karlsson³

et al. 2011

BMJ Quality & Safety

124

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OBJECTIVE To evaluate the effects of a clinical pharmacist service on health-related quality of life (HRQL) and prescribing of drugs. METHODS A randomised controlled study was performed in two internal medicine wards. The intervention consisted of medication reviews with feedback to the physicians, drug treatment discussion with patients at discharge and medication reports. HRQL was evaluated at inclusion and after six months by self-rated global health (1: very poor; 5: very good) and by the EuroQol 5-dimension questionnaire (EQ-5D). Prescribing of drugs was analysed regarding three established drug-specific quality indicators (intervention and control patients) and potential drug-related problems (DRPs) during in-hospital care (intervention patients). RESULTS 345 patients (61% female; median age: 82) were analysed, 204 of whom (59%) completed the six-month HRQL follow-up. A total of 87 patients (53% of the intervention patients) received all parts of the intervention. Intention-to-treat analysis revealed no significant findings for any of the HRQL measures. Per-protocol analysis revealed significantly better HRQL in the intervention group at six-month follow-up as measured by global health (mean: 3.14 (SD: 0.87) vs 2.77 (0.94), p=0.020), but not as measured by summarised EQ-5D index (0.48 (0.36) vs 0.43 (0.37), p=0.57). The number of potentially inappropriate prescribings per patient according to the quality indicators (admission vs discharge) was 0.35 (0.73) versus 0.38 (0.72), p=0.47 (control patients), and 0.39 (0.83) versus 0.26 (0.56), p=0.039 (intervention patients who received the intervention). In the intervention group, 133 relevant potential DRPs were identified in 81 patients, 55 of which (41%) were acted upon by the attending physician. CONCLUSION A clinical pharmacist service during inpatient care may improve quality of prescribing and patients' HRQL. Trial registration clinicaltrials.gov Identifier: NCT01016301.

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Section: Discussionsupporting

confidence: 84%

Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial

Bladh

Ottosson²,

Karlsson³

et al. 2011

BMJ Quality & Safety

124

View full text Add to dashboard Cite

show abstract

“…Seven studies targeting prescribing of medications looked at incorporating pharmacist review, with or without physician involvement, into clinical pathways on or after admission to care home [55-57,61-63,65]. Other, more targeted interventions considered protocols for the withdrawal of hypnotics [54], neuroleptics [59,66], anti-depressants [58] and anti-Parkinsonian [67] drugs.…”

Section: Resultsmentioning

confidence: 99%

A systematic mapping review of Randomized Controlled Trials (RCTs) in care homes

et al. 2012

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BackgroundA thorough understanding of the literature generated from research in care homes is required to support evidence-based commissioning and delivery of healthcare. So far this research has not been compiled or described. We set out to describe the extent of the evidence base derived from randomized controlled trials conducted in care homes.MethodsA systematic mapping review was conducted of the randomized controlled trials (RCTs) conducted in care homes. Medline was searched for “Nursing Home”, “Residential Facilities” and “Homes for the Aged”; CINAHL for “nursing homes”, “residential facilities” and “skilled nursing facilities”; AMED for “Nursing homes”, “Long term care”, “Residential facilities” and “Randomized controlled trial”; and BNI for “Nursing Homes”, “Residential Care” and “Long-term care”. Articles were classified against a keywording strategy describing: year and country of publication; randomization, stratification and blinding methodology; target of intervention; intervention and control treatments; number of subjects and/or clusters; outcome measures; and results.Results3226 abstracts were identified and 291 articles reviewed in full. Most were recent (median age 6 years) and from the United States. A wide range of targets and interventions were identified. Studies were mostly functional (44 behaviour, 20 prescribing and 20 malnutrition studies) rather than disease-based. Over a quarter focussed on mental health.ConclusionsThis study is the first to collate data from all RCTs conducted in care homes and represents an important resource for those providing and commissioning healthcare for this sector. The evidence-base is rapidly developing. Several areas - influenza, falls, mobility, fractures, osteoporosis – are appropriate for systematic review. For other topics, researchers need to focus on outcome measures that can be compared and collated.

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“…A study by Ulfvarson et al32 assessed the impact of medication reviews conducted by a specialist in clinical pharmacology and a specialist in cardiology among 80 nursing home residents (mean age, 87 years) in 9 nursing homes over a 3-month period. Symptoms related to heart failure or adverse reactions to cardiovascular drugs were recorded using a questionnaire.…”

Section: Resultsmentioning

confidence: 99%

“…Unfortunately, clinical outcomes were much less likely to be improved significantly, probably because the studies were underpowered to detect such differences in multifactorial outcomes. One positive finding is that 3 recent studies24,26,32 did examine medication-related adverse patient events.…”

Section: Discussionmentioning

confidence: 99%

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

Marcum

Handler

Wright

et al. 2010

The American Journal of Geriatric Pharmacotherapy

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Randomized controlled intervention in cardiovascular drug treatment in nursing homes

Abstract: Intervention did not affect cardiovascular symptoms. Drug revisions should involve more than one class of drugs in order to be cost-effective.

Cited by 13 publications

References 14 publications

Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial

Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial

A systematic mapping review of Randomized Controlled Trials (RCTs) in care homes

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

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