Medication supply and polypharmacy in long-term care : An overview of possible interventions and the question of afunctioning concept

Abstract

Polypharmacy and the resulting problems lead to considerable consequences for those affected. There are also considerable problems with the medication management. Which interventions and programs for optimizing the supply of medication are available for nursing homes and which implementation problems can be expected? A literature search was carried out for interventional studies in nursing homes in Germany, with a focus on improving medication safety. A total of six programs were identified for which evaluation results are available. Despite amostly multimodal approach with several pillars of intervention (e.g., medication reviews, further education and training, development of aids), the results are largely disappointing. The effects on the number of prescriptions in general, specific medication groups or outcome parameters such as hospital admissions could only be shown in one study, whereby, selection bias could also be at least partly responsible for this. Interdisciplinary collaboration and the implementation of medication recommendations formulated in reviews by the responsible physicians are the main problem areas. At the same time, too little attention is paid to the central role of nurses in the entire process and they are not actively promoted enough. This could be one of the reasons for the difficulties in implementation in practice. There are nearly no significant changes as aresult of the interventions implemented in the studies reviewed. In particular, interprofessional cooperation, especially the skills of nurses and the reluctance on the part of physicians, should probably be given more attention.