Abstract
In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (−0.38, 95% confidence intervals (CI) −0.69 to −0.07) and 12 months (−0.47, 95%CI −0.84 to −0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57–5.53) or mortality (relative risk 0.81, 95%CI 0.48–1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement.
Highlights
Increasing multimorbidity is contributing to increasing medication regimen complexity in residential aged care facilities (RACFs), with more than one-third of residents having five or more daily medication administration times [1,2,3,4]
In these pre-planned secondary analyses, we evaluated whether the impact of medication regimen simplification on the number of medication administration times observed at 4 months was sustained at 8 and 12 month follow up, and investigated the impact on falls, hospitalization, and mortality over 12 months
A 12 month retrospective cohort study involving 204 older Australians with chronic kidney disease who were discharged from hospital (21% were discharged to RACFs) showed that medication regimen complexity was not associated with 30 day hospital readmission, but was associated with a shorter time to readmission over 12 months [15]
Summary
Increasing multimorbidity is contributing to increasing medication regimen complexity in residential aged care facilities (RACFs), with more than one-third of residents having five or more daily medication administration times [1,2,3,4]. One population-based study observed associations between regimen complexity and mortality over 3 years for both community and RACF-dwelling older people [9]. A prospective study of Australian RACF residents identified an association between increased medication regimen complexity and 12 month hospitalization [6]. In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial (RCT), structured medication regimen simplification significantly reduced the number of daily medication administration times in the intervention arm at 4 months post-study entry [25]. No differences were observed between study arms in the rate of falls, hospitalizations or mortality at 4 month follow up In these pre-planned secondary analyses, we evaluated whether the impact of medication regimen simplification on the number of medication administration times observed at 4 months was sustained at 8 and 12 month follow up, and investigated the impact on falls, hospitalization, and mortality over 12 months
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