Medication review interventions to reduce hospital readmissions in older people

Dautzenberg, Lauren; Bretagne, Lisa; Koek, Huiberdina L.; Tsokani, Sofia; Zevgiti, Stella; Rodondi, Nicolas; Scholten, R. J. P. M.; Rutjes, Anne W S; Nisio, Marcello Di; Raijmann, Renee C. M. A.; Emmelot-Vonk, Mariëlle H.; Jennings, Emma; Dalleur, Olivia; Mavridis, Dimitris; Knol, Wilma

doi:10.1111/jgs.17041

Cited by 56 publications

(47 citation statements)

References 58 publications

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“…A recent systematic review highlights the paucity of research into the impact of optimizing prescriptions on clinical outcomes in older people living with frailty [ 55 ]. However, there is some evidence that MR can reduce the number of hospital readmissions among older people [ 56 ] and can prevent the decline of mental health, with no significant effects on other outcome measurements, apart from a reduction in the number of prescribed medications [ 57 , 58 ]. Thus, overall it is accepted that several studies suggest that medication optimization could be safe, feasible well-tolerated, and lead to important benefits [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home

Molist-Brunet

Sevilla-Sánchez

Puigoriol-Juvanteny

et al. 2022

IJERPH

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(1) Background: aging is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. A periodic medication review (MR) in frail older people leads to optimizing medication use. The aims of the study were to perform a comparative analysis of the impact of place of residence (own home versus nursing home) in a cohort of older patients on the characteristics of the baseline therapeutic plan and characteristics of the therapeutic plan after an MR; (2) Methods: Study with paired pre- and post-MR data based on person-centred prescription, with a follow-up assessment at three months. Patients who lived either in their own home or in a nursing home were recruited. We selected patients of 65 years or more with multimorbidity whose General Practitioner identified difficulties with the prescription management and the need for an MR. Each patient’s treatment was analysed by applying the Patient-Centred Prescription (PCP) model; (3) Results: 428 patients. 90% presented at least one inappropriate prescription (IP) in both settings. In nursing homes, a higher number of implemented optimization proposals was detected (81.6% versus 65.7% (p < 0.001)). After the MR, nursing-home patients had a greater decrease in their mean number of medications, polypharmacy prevalence, therapeutic complexity, and monthly drug expenditure (p < 0.001); (4) Conclusions: PCP model detected a high number of IP in both settings. However, after an individualized MR, nursing-home patients presented a greater decrease in some pharmacological parameters related to adverse events, such as polypharmacy and therapeutic complexity, compared to those living at home. Nursing homes may be regarded as a highly suitable scenario to carry out a periodic MR, due to its high prevalence of frail people and its feasibility to apply the recommendations of an MR. Prospective studies with a robust design should be performed to demonstrate this quasi-experimental study along with a longitudinal follow-up on clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home

Molist-Brunet

Sevilla-Sánchez

Puigoriol-Juvanteny

et al. 2022

IJERPH

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“…Medication review is a widely used strategy and with better outcomes to reduce potentially inappropriate prescribing (PIP) in hospitalized older adults. However, in a recent review, Dautzenberg et al (2021) reported that the heterogeneity between studies does not allow reaching significant conclusion. According to dos Santos et al (2019) , the choice of outcome measures, study design, and methodological quality of medication review studies make it difficult to analyze the effectiveness of this strategy.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Interventions to Reduce Potentially Inappropriate Medication in Older Patients: A Systematic Review

et al. 2022

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Background: Age-related multiple comorbidities cause older adults to be prone to the use of potentially inappropriate medicines (PIM) resulting in an increased risk of adverse events. Several strategies have emerged to support PIM prescription, and a huge number of interventions to reduce PIM have been proposed. This work aims to analyze the effectiveness of PIM interventions directed to older adults.Methods: A systematic review was performed searching the literature in the MEDLINE PubMed, EMBASE, and Cochrane scientific databases for interventional studies that assessed the PIM interventions in older adults (≥65 years).Results: Forty-seven articles were included, involving 52 to 124,802 patients. Various types of interventions were analyzed such as medication review, educational strategies, clinical decision support system, and organizational and multifaceted approaches. In the hospital, the most successful intervention was medication review (75.0%), while in primary care, the analysis of all included studies revealed that educational strategies were the most effective. However, the analysis of interventions that have greater evidence by its design was inconclusive.Conclusion: The results obtained in this work suggested that PIM-setting-directed interventions should be developed to promote the wellbeing of the patients through PIM reduction. Although the data obtained suggested that medication review was the most assertive strategy to decrease the number of PIM in the hospital setting, more studies are necessary.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021233484], identifier [PROSPERO 2021 CRD42021233484].

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“…In addition, the growing use of computerized prescriptions has allowed the integration of digital prescription support tools aimed at automatically alerting prescribers when patients are at risk of interacting or inappropriate drugs. In some countries, this improvement could also be due to the spread of pharmaceutical care and medication review services [ 30 ], which in local experiences have been shown to improve prescriptive quality and clinical outcomes [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Prescribing among Elderly Outpatients: Evaluation of Temporal Trends 2012–2018 in Piedmont, Italy

Galimberti

Casula

Scotti

et al. 2022

IJERPH

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Pharmacological intervention is one of the cornerstones in the treatment and prevention of disease in modern healthcare. However, a large number of drugs are often prescribed and used inappropriately, especially in elderly patients. We aimed at investigating the annual prevalence of potentially inappropriate prescriptions (PIPs) among older outpatients using administrative healthcare databases of the Piedmont Region (Italy) over a seven-year period (2012–2018). We included all Piedmont outpatients aged 65 years or older with at least one drug prescription per year. Polypharmacy and the prevalence of PIPs according to the ERD list explicit tool were measured on an annual basis. A range between 976,398 (in 2012) and 1,066,389 (in 2018) elderly were evaluated. Among them, the number of subjects with at least one PIP decreased from 418,537 in 2012 to 339,764 in 2018; the prevalence significantly reduced by ~25% over the study period. The stratified analyses by age groups and sex also confirmed the downward trend and identified several differences in the most prevalent inappropriately prescribed drugs. Overall, despite a reduction in PIP prevalence, one out of three older outpatients was still exposed to inappropriateness, highlighting the extensive need for intervention to improve prescribing.

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Medication review interventions to reduce hospital readmissions in older people

Cited by 56 publications

References 58 publications

Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home

Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home

Effectiveness of Interventions to Reduce Potentially Inappropriate Medication in Older Patients: A Systematic Review

Potentially Inappropriate Prescribing among Elderly Outpatients: Evaluation of Temporal Trends 2012–2018 in Piedmont, Italy

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