Reducing potentially inappropriate drug prescribing in nursing home residents: effectiveness of a geriatric intervention

Cool, Charlène; Cestac, Philippe; McCambridge, Cécile; Rouch, Laure; Barreto, Philipe de Souto; Rolland, Yves; Lapeyre‐Mestre, Maryse

doi:10.1111/bcp.13598

Cited by 12 publications

(20 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Five trials performed in European Union (EU) countries NHs were published after these SRs and are summarized in Table 1 [11,[17][18][19][20]. These were all multicenter studies-three were cluster-randomized controlled trials-and involved multidisciplinary interventions mainly consisting of education of HCPs and MR. None involved a CDSS component.…”

Section: Interventions To Optimize Prescribing For the Whole Medicatimentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

View full text Add to dashboard Cite

Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. Methods We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. Results Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. Conclusion Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.

show abstract

Section: Interventions To Optimize Prescribing For the Whole Medicatimentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

View full text Add to dashboard Cite

show abstract

“…study and our analysis: in our investigation, the most frequently prescribed PIMs within the classe of benzodiazepines and antipsychotics were lorazepam (at a daily dose of 2 mg or more) and olanzapine (at a daily dose of 10 mg or more), respectively, as opposed to bromazepam and risperidone in the Cool et al. study 31 . This is remarkable because the German PRISCUS list considers risperidone as a drug with an overall favorable benefit‐to‐risk profile in elderly patients and as a suitable alternative to first‐generation antipsychotics and olanzapine (>10 mg/d) 15 …”

Section: Discussionmentioning

confidence: 58%

“…As information on MRPs in gerontopsychiatric inpatients is scarce, we compared our results with the data published by Cool and colleagues who investigated the frequency of potentially inappropriate drug prescribing in French nursing home residents 31 . Of note, the MRP definition used in our study included the definition of potentially inappropriate drug prescribing used in the Cool et al.…”

Section: Discussionmentioning

confidence: 97%

Medication‐related problems in geriatric psychiatry—a retrospective cohort study

Heck

Ihlefeld

Krause

et al. 2022

Int J Geriat Psychiatry

View full text Add to dashboard Cite

Objectives: Information on medication-related problems (MRPs) in elderly psychiatric patients is scarce. In the present study, we analyzed the frequency and characteristics of MRPs in patients ≥60 years treated on the gerontopsychiatric ward of Hannover Medical School in 2019. Methods: Taking advantage of an interdisciplinary approach, two independent investigators screened hospital discharge letters of 230 psychiatric inpatients for clinically relevant MRPs, followed by validation through an interdisciplinary expert panel. Drug interactions as a subset of MRPs were analyzed with the aid of two different drug interaction programs. Results: 230 patients (63.0% female, mean age 73.7 � 8.4 years, median length of stay 18 days) were prescribed a median of 6 drugs. In total, 2180 MRPs were detected in the study population and 94.3% of the patients exhibited at least one MRP. Patients displayed a median of 7 MRPs (interquartile range 3-15). Pharmacodynamic interactions accounted for almost half of all MRPs (48.1%; 1048/2180).The number of drugs prescribed and the number of MRPs per patient showed a strong linear relationship (adjusted R 2 = 0.747). Conclusion:An exceedingly high proportion of elderly psychiatric inpatients displayed clinically relevant MRPs in the present study, which may be explained by the multimorbidity prevalent in the study population and the associated polypharmacy.The number of drug interactions was largely in accordance with previous studies. As a novel finding, we detected that a considerable proportion of elderly psychiatric inpatients were affected by potential prescribing omissions, potentially inappropriate duplicate prescriptions, and insufficient documentation.

show abstract

“…Numerous studies have also shown the effect of targeted interventions comprising different health care professionals and methods of reducing the overall consumption of medications in nursing homes. In particular, interprofessional (nurse, pharmacist, general practitioner) interventions that involve medication review with a pharmacist [ 13 , 23 ]; specialised geriatric education for nursing home staff [ 24 ], auditing prescriptions based on geriatric risk assessment [ 25 ]; or retrospective drug utilization review activities have all been effective in improving the quality of prescriptions [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Indicators Improve the Prescription Quality of Drugs with Anticholinergic Properties in Nursing Homes

Sanchez

Chrusciel²,

Ndiongue³

et al. 2021

IJERPH

View full text Add to dashboard Cite

Aim: The objective of this study was to assess the impact of a collaborative therapeutic optimization program on the rate of potentially inappropriate prescription of drugs with anticholinergic properties in nursing homes. Methods: Quasi-experimental study in 37 nursing homes in France. The intervention included the use of quality indicators for prescriptions combined with educational sessions and dedicated materials for nursing home staff (unlimited access to study material for staff, including nurses, general practitioners, pharmacists). Indicators were calculated based on routine data collected from an electronic pill dispenser system. The primary outcome was the presence of at least one prescription containing ≥1 drug from a list of 12 drugs with anticholinergic properties. A difference-in-differences analysis was conducted at 18 months as well as propensity score weighting to minimize any potential indication bias. A generalized estimating equation model estimated the probability of being prescribed at least one target drug at any time during a 9-month period for each resident. Results: In total, 33 nursing homes (intervention group: n = 10; control group: n = 23) were included, totalling 8137 residents. There was a decrease in the use of drugs with anticholinergic properties over time in both groups, as well as a decline in the intervention group compared to the control group (Odds Ratio: 0.685, 95% CI: 0.533, 0.880; p < 0.01) that was attributable to the intervention. An estimated 49 anticholinergic properties drug prescriptions were avoided by the intervention. Conclusion: This study found that an intervention based on indicators derived from routine prescription data was effective in reducing use of drugs with anticholinergic properties prescriptions in nursing homes.

show abstract

Reducing potentially inappropriate drug prescribing in nursing home residents: effectiveness of a geriatric intervention

Abstract: This intervention based on a global geriatric education resulted in a significant reduction of PIDP at patient level.

Cited by 12 publications

References 55 publications

Interventions to optimize medication use in nursing homes: a narrative review

Interventions to optimize medication use in nursing homes: a narrative review

Medication‐related problems in geriatric psychiatry—a retrospective cohort study

Risk Indicators Improve the Prescription Quality of Drugs with Anticholinergic Properties in Nursing Homes

Contact Info

Product

Resources

About