A multidisciplinary approach to improve drug therapy in nursing homes

Abstract

Management of drug therapy in nursing home patients is challenging due to complex health problems, use of multiple medications, and age-related changes in pharmacokinetics and pharmacodynamics. The objective of this study was, first, to examine the effect of systematic medication reviews conducted by multidisciplinary nursing home teams on prescribing quality and, second, to evaluate if drug therapy changes were maintained over time. Patients in a large nursing home in Oslo, Norway, were prospectively followed during a 1.5-year period. Systematic comprehensive medication reviews were carried out and the identified drug-related problems (DRPs) were discussed at multidisciplinary team meetings. After 3 months, the patients’ drug regimens were reviewed again to evaluate if drug therapy changes were maintained. Altogether, 93 patients were included (89% women, mean age 87 years). In total, 234 DRPs were identified in 82 patients, and 151 drug therapy changes were performed in 73 patients. The most common DRPs were ‘drug treatment without a clear indication’ (37% of all DRPs) and ‘treatment with an inappropriate drug’ (20%). After 3 months, 85 patients (91%) were available for follow-up. In these patients, 133 (88%) of the drug therapy changes were maintained, and the mean number of DRPs had decreased from 2.6 to 1.0 per patient (P < 0.01). We were able to demonstrate that medication reviews conducted by multidisciplinary teams were effective to improve the quality of drug treatment in nursing home patients by significantly reducing both number of drugs and number of DRPs. The large majority of drug therapy changes were maintained after 3 months.

Drug-Related Problems Identified in a Sample of Portuguese Institutionalised Elderly Patients and Pharmacists’ Interventions to Improve Safety and Effectiveness of Medicines

“…The number of DRPs identified in this study was considerably higher than what was expected based on previous literature [15, 26, 27, 30, 31]. However, it should be noted that most of these studies did not differentiate between potential and manifest DRPs and did not use the Granada classification, thus making comparison impossible.…”

“…The second more frequent DRP was DRP 2, similar to what has been reported as “medicine with unclear indication” [15, 30]. However, it should be noted that there was an enormous difference between potential and manifest DRPs, with the latter representing only 2 % of all DRPs detected.…”

“…The initial sample was prescribed a mean of 11 medicines per day, varying between 5 and 18, which is also similar to results published previously [11, 15, 16, 24, 27, 28]. …”

“…The START/STOPP criteria have been gaining prominence in Europe [10] and there are reports using the McLeod criteria [11], Priscus list [12] and even nationally developed classifications [13, 14]. However, few reports of pharmacist-led medication reviews focus on the identification of DRPs, and these have either used the Pharmaceutical Care Network Europe classification [15, 16] or the DOCUMENT classification [17]. The Dader method has been used in nursing homes [18] but, to our knowledge, no paper has yet described the nature of DRP detected using the Granada classification to guide pharmacist-led medication reviews [19, 20].…”

Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway

“…A drug-related problem (DRP) is ‘an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes’ [ 8 ]. Previous Norwegian studies using different tools for identifying drug–drug interactions [ 9 ] and potentially inappropriate prescriptions for the elderly [ 10 , 11 ] have reported that NH patients are frequently exposed to DRPs [ 1 , 12 , 13 ].…”