The Effect of the NorGeP-NH on Quality of Life and Drug Prescriptions in Norwegian Nursing Homes: A Randomized Controlled Trial.

Enrico Callegari,Sverre Bergh,Jurate Šaltytė Benth,Cato Grønnerød,Geir Selbæk

doi:10.3390/pharmacy10010032

Abstract

Background: The effect of the Norwegian General Practice–Nursing Home (NorGeP–NH) criteria has never been tested on clinical outcomes in nursing home (NH) residents. We performed a cluster-randomized trial in Norwegian NHs and tested the effect of NorGeP–NH on QoL (primary outcome), medication prescriptions, and physical and mental health (secondary outcomes) for the enrolled residents; Methods: Fourteen NHs were randomized into intervention NHs (iNHs) and control NHs (cNHs). After baseline data collection, physicians performed NorGeP–NH on the enrolled residents. We assessed the difference between cNHs and iNHs in the change in primary outcome from baseline to 12 weeks and secondary outcomes from baseline to eight and 12 weeks by linear mixed models; Results: One hundred and eight residents (13 lost to follow-up) and 109 residents (nine lost to follow-up) were randomized to iNHs and cNHs, respectively. Difference in change in QoL at 12 weeks between cNHs and iNHs was not statistically significant (mean (95% CI)): −1.51 (−3.30; 0.28), p = 0.101). We found no significant change in drug prescriptions over time. Difference in depression scores between cNHs and iNHs was statistically significant after 12 weeks. Conclusions: Our intervention did not affect QoL or drug prescriptions, but reduced depression scores in the iNHs. NorGeP–NH may be a useful tool, but its effect on clinical outcomes may be scarce in NH residents. Further studies about the effectiveness of NorGeP–NH in other healthcare contexts and settings are recommended.

Highlights

It is well established that polypharmacy, often defined as the use of more than five concomitant drugs [1], is prevalent in nursing homes (NHs) and is associated with frailty, hospitalization, cognitive and physical impairment, falls, and mortality [2,3].In the past years, several explicit lists, such as Beers Criteria [4,5], START/STOPP [6], EU (7)-PIM [7], the PRISCUS list [8], and NorGeP [9], have been introduced to identify potentially inappropriate medications (PIM) in older adults
Our trial did not show any significant difference in change in quality of life (QoL) scores between intervention NHs (iNHs) and control NHs (cNHs) from BL to 12-week follow-up
Even though we found a statistically significant reduction in QoL among cNHs residents from BL to 12-week follow-up, this reduction was not relevant from a clinical perspective, according to what we assumed to be a clinically important reduction (33%)

Summary

Introduction

It is well established that polypharmacy, often defined as the use of more than five concomitant drugs [1], is prevalent in nursing homes (NHs) and is associated with frailty, hospitalization, cognitive and physical impairment, falls, and mortality [2,3].In the past years, several explicit lists, such as Beers Criteria [4,5], START/STOPP [6], EU (7)-PIM [7], the PRISCUS list [8], and NorGeP [9], have been introduced to identify potentially inappropriate medications (PIM) in older adults. RCTs aiming to evaluate the effect of medication reviews on clinical, drug-related, and organizational outcomes are heterogeneous, do not always use standardized clinical outcomes, and lead to opposite or not always robust conclusions [16,17]. We performed a cluster-randomized trial in Norwegian NHs and tested the effect of NorGeP–NH on QoL (primary outcome), medication prescriptions, and physical and mental health (secondary outcomes) for the enrolled residents; Methods: Fourteen NHs were randomized into intervention NHs (iNHs) and control NHs (cNHs). Difference in change in QoL at 12 weeks between cNHs and iNHs was not statistically significant (mean (95% CI)): −1.51 (−3.30; 0.28), p = 0.101). Difference in depression scores between cNHs and iNHs was statistically significant after 12 weeks. Conclusions: Our intervention did not affect QoL or drug prescriptions, but reduced depression scores in the iNHs

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