Nursing home residents are among the frailest patient groups with a high number of co-morbidities and a high use of medicines. Inappropriate polypharmacy (i.e. often overprescribing) is one of the major problems in the nursing home population increasing the number of adverse drug reactions, falls, hospital admissions, mortality as well as having an impact on health care utilization. Multidisciplinary medication reviews have a great potential to reduce inappropriate medication use. The purpose of this study is to determine the efficacy of a multidisciplinary medication review model focussing on discontinuing inappropriate medication in a cluster randomized controlled trial in 600 nursing home residents. The primary outcome measure is the difference in proportion of residents who successfully discontinued medication between intervention and control group after four months. Secondary outcome measures will be the drug burden index, adverse drug withdrawal events related to the discontinued medication, death, referral to hospitals and quality of life.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Enrollment
992
Consists of the following steps: * 1\. Elderly care physician and nursing staff evaluate with the patient the experience of taking medicines, adverse drug reactions and patient's preferences. * 2\. Pharmacist reviews medication to identify drug related problems using START/STOPP en Beers criteria. * 3/4. Meeting of elderly care physician, pharmacist. Possibilities to discontinue prescribed medication will be examined resulting in pharmaceutical care plan that optimizes the patient's medication i.e. which inappropriate medication should be discontinued following a prioritization and time schedule. * 5\. Execution of pharmaceutical care plan according to agreed schedule.
University of Groningen
Groningen, Provincie Groningen, Netherlands
Successful medication discontinuation
The number of residents for whom ≥1 inappropriate medication(s) are succesfully discontinued i.e. without relapse or severe withdrawal effects
Time frame: 4 months
Medication initiation
Number of residents for whom ≥1 medication(s) are initiated (s) that should be started on the basis of the Screening Tool to Alert doctors to Right Treatment (START) criteria
Time frame: 4 months
Dose adjustment
Number of residents for whom ≥1 dose(s) are lowered or increased
Time frame: 4 months
Safer alternative medication
The percentage of residents for whom ≥1 medication(s) is replaced by a safer alternative
Time frame: 4 months
Drug burden index
A measure of a person's cumulative exposure to anticholinergic and sedative medications, which has been associated with falls in nursing home patients
Time frame: 4 months
Quality of Life
Quality of life will be measured using a disease specific instrument (DQI (Scholzel-Dorenbosch et al, in press) and a generic instrument EQ-5D-5L for all patients (Herdman et al, 2011).
Time frame: 4 months
adverse drug withdrawal events
The rate of adverse drug withdrawal events related to the discontinued medication
Time frame: 4 months
Death
Incidence of death
Time frame: 4 months
Hospital admission
Hospital admission
Time frame: 4 months
Falling
Defined as any event in which a nursing home resident touches the ground in an unintentional sudden manner without cues of emergency
Time frame: 4 months
Bone fractures
Bone fractures caused by falling
Time frame: 4 months
number of visits to outpatient clinics / emergency rooms / by medical consultants
number of visits to outpatient clinics, emergency rooms, number of visits by medical consultants i.e. physicians who visit the patients in the nursing homes,
Time frame: 4 months
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