Impact of a Multifaceted, Pharmacist-Led Intervention on Psychotropic Medication Use for Residents of Aged Care Facilities: A Parallel Cluster Randomized Controlled Trial.

Abstract

To investigate the effect of a multifaceted intervention on reduction in psychotropic medication use, falls, agitation, emergency department (ED) visits, and hospitalization in residential aged care facilities (RACFs). Parallel cluster randomized controlled trial. RACFs were randomized to the multifaceted intervention, Medication Management Consultancy (MMC) (n= 5) or control (n= 6) groups. MMC, comprising online education, medication audits, and resources on psychotropic medications and nonpharmacological strategies, educates RACF staff to help reduce the use of antipsychotic medication among RACF residents through a comprehensive understanding of behavioral and psychological symptoms of dementia. A total of 439 residents from 11 RACFs in Western Australia. The primary outcome was change in monthly total equivalent doses (mg) of antipsychotic, antidepressant, and benzodiazepine medication use over 12months compared with a control group. Clinical outcomes included falls, restraints, agitation, ED visits, hospitalization, and knowledge of psychotropic medications among RACF staff at pre- and postintervention were measured. The duration of the intervention was 3 to 6months. Data were collected at T0 (baseline), T1 (6months), and T2 (12months). The MMC group showed a significant 44% reduction in antipsychotic use compared with the control group at T1 (incidence rate ratios [IRR], 0.56; 95% CI, 0.32-0.99; P= .048) and also significantly reduced the number of ED visits at T1 (IRR, 0.15; 95% CI, 0.06-0.35; P < .0005) and T2 (IRR, 0.04; 95% CI, 0.01-0.13; P < .0005). Staff knowledge about psychotropic medications improved significantly from T0 to T1 and from T0 to T2. Reduction in antidepressant use at either T1 or T2 and benzodiazepine use, compared with control, at T1 and T2 were not significantly different. Other clinical outcomes showed limited impact. The MMC intervention reduced the use of antipsychotics and ED visits and improved staff knowledge in RACFs, which impacts the safety and quality of aged care in Australia.