Abstract
BackgroundIn nursing home residents (NHRs), polypharmacy is widespread, accompanied by elevated risks of medication related complications. Managing medication in NHRs is a priority, but prone to several challenges, including interprofessional cooperation. Against this background, we implemented and tested an interprofessional intervention aimed to improve medication appropriateness for NHRs.MethodsA non-randomized controlled study (SiMbA; “Sicherheit der Medikamentherapie bei AltenheimbewohnerInnen”, Safety of medication therapy in NHRs) was conducted in six nursing homes in Austria (2016–2018). Educational training, introduction of tailored health information technology (HIT) and a therapy check process were combined in an intervention aimed at healthcare professionals. Medication appropriateness was assessed using the Medication Appropriateness Index (MAI). Data was collected before (t0), during (t1, month 12) and after (t2, month 18) intervention via self-administered assessments and electronic health records.ResultsWe included 6 NHs, 17 GPs (52.94% female) and 240 NHRs (68.75% female; mean age 85.0). Data of 159 NHRs could be included in the analysis. Mean MAI-change was − 3.35 (IG) vs. − 1.45 (CG). In the subgroup of NHRs with mean MAI ≥23, MAI-change was − 10.31 (IG) vs. −3.52 (CG). The intervention was a significant predictor of improvement in MAI when controlled for in a multivariable regression model.ConclusionsImprovement of medication appropriateness was clearest in residents with inappropriate baseline MAI-scores. This improvement was independent of variances in certain covariates between the intervention and the control group. We conclude that our intervention is a feasible approach to improve NHRs’ medication appropriateness.Trial registrationDRKS Data Management, ID: DRKS00012246. Registered 16.05.2017 – Retrospectively registered.
Highlights
In nursing home residents (NHRs), polypharmacy is widespread, accompanied by elevated risks of medication related complications
Improvement of medication appropriateness was clearest in residents with inappropriate baseline Medication Appropriateness Index (MAI)-scores
This improvement was independent of variances in certain covariates between the intervention and the control group
Summary
In nursing home residents (NHRs), polypharmacy is widespread, accompanied by elevated risks of medication related complications. Managing medication in NHRs is a priority, but prone to several challenges, including interprofessional cooperation. Against this background, we implemented and tested an interprofessional intervention aimed to improve medication appropriateness for NHRs. Ensuring medication appropriateness in residents of long-term care facilities is known to be a challenge for all involved health care professionals [1, 2]. In a systematic review on polypharmacy (defined as ≥5 concurrent medications) in nursing home residents (NHRs), prevalence in 11 international studies ranged from 38.1 to 91.2% [6]. Polypharmacy is a well-documented risk factor for inappropriate medication [8,9,10]
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