Effectiveness of a multidisciplinary home‐based medication review program in reducing healthcare utilization among older adult Singaporeans

Ong, K. C. G.; Cheen, McVin Hua Heng; Chng, Joanne Swee Gek; Chen, Li Li; Ng, Sock Mui; Lim, Seng Han; Lim, Pei Li; Chang, Wei Terk

doi:10.1111/ggi.12706

Cited by 9 publications

(17 citation statements)

References 28 publications

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“…Five studies were RCTs, eight were quasi-experiments (four prospective controlled pre–post design and one retrospective controlled pre–post design) and three were retrospective non-controlled observational studies. Four interventions took place in the USA,14–17 while two interventions were set in the UK,18 19 New Zealand20 21 and Singapore 22 23. Additionally, there was one intervention each in France,24 Australia,25 Denmark,26 Mexico27 and Hong Kong 28.…”

Section: Resultsmentioning

confidence: 99%

“…Two quasi-experimental studies presented low risk of bias,17 21 while the others were assessed as showing unclear risks due to a lack of randomisation15 24 27 and programme implementation issues 21. The remaining studies presented a high risk of bias due to elements of the methodological design or analysis16 19 22 23 28 and baseline differences 14 27. The assessment of risk of bias of individual studies is detailed in online supplementary appendix 4.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, Ong et al present a home-based medication review programme led by a pharmacist, accompanied by a care coordinator, in liaison with other medical specialists. The programme provided pharmacological counselling, and the identification of drug-related problems 22…”

Section: Resultsmentioning

confidence: 99%

“…A wide variety of multidisciplinary teams, in terms of composition and size, was observed across the studies. Two interventions were pharmacist-led, accompanied by other staff such as care coordinators22 or cultural workers in a context of diversity 21. All other studies described nurses playing leading roles, such as case managers 20 23 24.…”

Section: Resultsmentioning

confidence: 99%

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Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review

2019

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ObjectivesTo synthesise existing literature on interventions addressing a new concept of avoidable displacement from home for older people with multimorbidity or frailty. The review focused on home-based interventions by any type of multidisciplinary team aimed at reducing avoidable displacement from home to hospital settings. A second objective was to characterise these interventions to inform policy.DesignA systematic search of the main bibliographic databases was conducted to identify studies relating to interventions addressing avoidable displacement from home for older people. Studies focusing on one specific condition or interventions without multidisciplinary teams were excluded. A narrative synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach.ResultsThe search strategy was performed using the following electronic databases: the American National Library of Medicine and the National Institutes of Health (PubMed), Scopus, Cochrane Library (Central and CDRS), CINAHL, Social Care Online, Web of Science as well as the database of the Latin American and Caribbean Health Sciences Literature. The database search was done in September 2018 and completed in October 2018. Overall 3927 articles were identified and 364 were retained for full text screening. Fifteen studies were included in the narrative review. Four themes were identified and discussed: (1) types of interventions, (2) composition of teams, (3) intervention effectiveness and (4) types of outcomes. Within intervention types, three categories of care types were identified; transitional care, case-management services and hospital at home. Each individual article was assessed in terms of risk of bias following Cochrane Collaboration guidelines.ConclusionsThe review identified some potential interventions and relevant topics to be addressed in order to develop effective and sustainable interventions to reduce the avoidable displacement from home of older people. However the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home. This finding reflects the complexity of these interventions and a lack of systematic data collection.PROSPERO registration numberCRD42018108116.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review

2019

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“…R. Carter et al, 2013;Doucette et al, 2007;Doucette et al, 2013;Du Pasquier & Aslani, 2008;Garcia et al, 2009;Huet et al, 2015;Lauffenburger et al, 2012;C. Y. Lee et al, 2012;A. T..…”

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Understanding Medicare part D beneficiaries’ decision making for using comprehensive medication review service

Zhang¹

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Clinical impact of an interdisciplinary patient safety program for managing drug-related problems in a long-term care hospital

et al. 2017

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Background Medication reviews intended to identify drug-related problems (DRPs) have been researched in primary care, acute care and nursing homes rather than in long-term care hospitals (LTCHs). Objectives To assess the clinical impact of an interdisciplinary pharmacotherapy quality improvement and patient safety program in elderly patients with polypharmacy admitted to an LTCH. Setting An interventional, longitudinal, prospective study was conducted in a Spanish LTCH Method A total of 162 elderly (≥ 70 years) patients with polypharmacy (≥ 5 medications) were included. Pharmacist conducted the pharmacotherapy follow-up of patients (reconciliation, pharmacotherapeutic optimization, educational interviews) from admission to discharge. Demographic, clinical and treatment-related variables were recorded. Main outcome measured Clinical impact of the program by DRP-based effectiveness and drug-related morbidity (DRM)-based safety indicators. Results 895 DRPs (median of 5 (1-23)) were identified in 153 (94.4%) patients. The most common DRPs were unnecessary drug (25.3%), dosage too high (24.9%) and a need for additional drug (24.8%). The most frequent pharmacotherapy recommendations were individualizing the dosage regimen (29.6%) and stopping (27.3%) or starting (21.9%) a drug. The mean implementation rate of pharmacotherapy recommendations was 90.9%. The effectiveness indicator revealed a 94.9% of prevented or resolved DRPs. The safety indicator showed an 89.3% of prevented or resolved DRM. Therefore, the program prevented or resolved 92.5% of adverse effects and 91.7% of suboptimal responses or therapeutic failures. Conclusion This interdisciplinary patient safety program seems to be a valuable approach to identify, prevent and resolve the high number of DRPs and potential DRM that elderly patients with polypharmacy admitted to an LTCH present.

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Effectiveness of a multidisciplinary home‐based medication review program in reducing healthcare utilization among older adult Singaporeans

Abstract: The multidisciplinary HBMR program was associated with reduced ED visits, hospital admissions, LOS and costs in older adult Singaporeans with multiple DRP. Geriatr Gerontol Int 2017; 17: 302-307.

Cited by 9 publications

References 28 publications

Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review

Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review

Understanding Medicare part D beneficiaries’ decision making for using comprehensive medication review service

Clinical impact of an interdisciplinary patient safety program for managing drug-related problems in a long-term care hospital

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