Abstract
BackgroundMedication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR’ health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists’ medication reviews linked with measures to strengthen interprofessional co-operation on NHR’ medication quality, health status and health care use.MethodsPragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist’s medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a “toolbox” to facilitate implementation in daily practice. Analysis: primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs.DiscussionThe trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany.Trial registrationRegistered in the German register of clinical studies (DRKS, study ID DRKS00013588, primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.
Highlights
Medication safety is an important health issue for nursing home residents (NHR)
Systematic procedures on how to co-operate are not in place [3], and the professional groups involved in medication management (GPs, nursing staff and pharmacists) have been shown to poorly communicate and undervalue each other’s competencies on this matter [4]
Evaluation Different parts of the study will be evaluated: 1) The awareness to the need for changing medication management and later the satisfaction with the change and the perceived benefit will be evaluated in all three workshops in a discussion and with additional questionnaires
Summary
Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This study investigates the effects of pharmacists’ medication reviews linked with measures to strengthen interprofessional co-operation on NHR’ medication quality, health status and health care use. The medication management of nursing home residents (NHR) is complex and can be challenging for all involved professions [1]. Due to the continuous contact with the NHR, nurses are in the best position to observe their health state They may, lack knowledge about geriatric pharmacotherapy and cannot decide which of the changes observed in health status might be associated with drug therapy. Systematic procedures on how to co-operate are not in place [3], and the professional groups involved in medication management (GPs, nursing staff and pharmacists) have been shown to poorly communicate and undervalue each other’s competencies on this matter [4]
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