Interventions to optimise prescribing for older people in care homes

Abstract

Background There is a substantial body of evidence that prescribing for care home residents is suboptimal and requires improvement. Consequently, there is a need to identify effective interventions to optimise prescribing and resident outcomes in this context. Objectives The objective of the review was to determine the effect of interventions to optimise prescribing for older people living in care homes.

The Effects of Clinical Decision Support Systems on Medication Safety: An Overview

“…Based on the criterion used by Beverley and Jeremy[26]: four studies is high quality [20 30 36 38]; Sixteen is medium quality [4 10 14–17 19 29 31–35 37 39 40] and 0 to 4 no study is low quality (Table 4). Meanwhile, the 20 SRs varied in the tools used to assess the methodological quality of their including studies: 10-point scale was used by six studies[4 16 19 20 32 34]; Two SRs conducted the processes based on the criteria developed by the Cochrane Effective Practice and Organization of Care (EPOC) Group [30 39]; The Cochrane Collaboration’s tool for assessing risk of bias was used by Bennett2003[33] and Alldred2013[38] and one study used the Downs and Black tool[37] (Table 5). …”

“…Evidence that CDSS significantly impacted patient outcomes was found in 18 out of 90 unique studies of the 13 SRs that examined this effect (20%).Only two of the 13 SRs found strong evidence that CDSS impacted patient outcomes: computer support for determining drug dose [36]and computerized medication dosing assistants [19] Three found limited evidence [16 17 29] and the remaining 8 SRs found insufficient evidence: computerized drug-lab alerts[31], computerized drug dose[15 20 30], computerized clinical decision support systems for drug prescribing[4 32 37 38] (Table 4). …”

“…We planned to examine the effects of CDSS on medication safety, four studies directly targeting medication error[10 39]or adverse drug events[37 38]. The majority of our studies (16 studies) focused on the medication/drug related outcome (i.e.…”

Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications in People With Dementia Resident in Care Homes: A Systematic Review

“…46 A systematic review of the implementation of psychosocial interventions for people with dementia in care homes found that active engagement of care-home staff and family members played a crucial role in successful implementation. 47 Similarly, systematic reviews on the more general topic of improving prescribing practice in care homes 48e53 also have been unable to make clear recommendations for future practice due to the varied nature of the design, interventions, outcomes, and results 49,50,53 and the poor quality of included studies. 48,51,52 …”

Reduction in the use of potentially inappropriate drugs among old people living in geriatric care units between 2007 and 2013

“…A recent Cochrane review indicated that interventions in care homes performed with clinical pharmacists involved led to identification and resolution of medication-related problems and improved medication appropriateness [37]. A newly published review indicated that there is not enough evidence for medication reviews in nursing homes concerning hard endpoints such as mortality or hospitalisation frequencies [38].…”