Abstract
Aim: The objective of this study was to assess the impact of a collaborative therapeutic optimization program on the rate of potentially inappropriate prescription of drugs with anticholinergic properties in nursing homes. Methods: Quasi-experimental study in 37 nursing homes in France. The intervention included the use of quality indicators for prescriptions combined with educational sessions and dedicated materials for nursing home staff (unlimited access to study material for staff, including nurses, general practitioners, pharmacists). Indicators were calculated based on routine data collected from an electronic pill dispenser system. The primary outcome was the presence of at least one prescription containing ≥1 drug from a list of 12 drugs with anticholinergic properties. A difference-in-differences analysis was conducted at 18 months as well as propensity score weighting to minimize any potential indication bias. A generalized estimating equation model estimated the probability of being prescribed at least one target drug at any time during a 9-month period for each resident. Results: In total, 33 nursing homes (intervention group: n = 10; control group: n = 23) were included, totalling 8137 residents. There was a decrease in the use of drugs with anticholinergic properties over time in both groups, as well as a decline in the intervention group compared to the control group (Odds Ratio: 0.685, 95% CI: 0.533, 0.880; p < 0.01) that was attributable to the intervention. An estimated 49 anticholinergic properties drug prescriptions were avoided by the intervention. Conclusion: This study found that an intervention based on indicators derived from routine prescription data was effective in reducing use of drugs with anticholinergic properties prescriptions in nursing homes.
Highlights
potentially inappropriate medications (PIMs) correspond to drugs that should not be prescribed in a specific population because the risk of adverse events clearly outweighs the clinical benefit, and safer or more effective alternatives exist [1,2,3]
Our study found that the collaborative therapeutic optimization program implemented in the intervention group significantly decreased the prescription of drugs with anticholinergic properties for nursing home residents during the study period
Our study observed a reduction across a sample of nursing homes that are comparable to the national average of private for-profit nursing homes in France in terms of the number and mean age of residents which may suggest that a potential fall in anticholinergic drugs at a wider scale would be possible in France with generalization of our intervention14
Summary
Nursing home residents are at increased risk of iatrogenic complications due to potentially inappropriate medications (PIMs) and polypharmacy. PIMs correspond to drugs that should not be prescribed in a specific population (such as nursing home residents) because the risk of adverse events clearly outweighs the clinical benefit, and safer or more effective alternatives exist [1,2,3]. PIMs are associated with both the increased use of healthcare services and an impaired quality of life [4,5,6]. In France, residents are prescribed an average of eight different drugs per day and, in some studies, have been shown to be given more 4.0/).
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