Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial

Sluggett, Janet K.; Chen, Esa Y H; Ilomäki, Jenni; Corlis, Megan; Emden, Jan Van; Hogan, Michelle; Caporale, Tessa; Keen, Claire; Hopkins, Ria; Ooi, Choon Ean; Hilmer, Sarah N.; Hughes, Georgina A.; Luu, Andrew; Nguyen, Kim‐Huong; Comans, Tracy; Edwards, Susan; Quirke, Lyntara; Patching, Allan; Bell, John

doi:10.1016/j.jamda.2020.02.003

Cited by 20 publications

(37 citation statements)

References 39 publications

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“…The higher rate of falls in the intervention arm at 12 months was not anticipated, particularly as no difference in fall rates between study arms was detected at 4 month follow up [25]. A higher proportion of residents in the intervention arm experienced one or more falls in the 12 months post-study entry, despite baseline functional assessments being well matched between the study arms.…”

Section: Resultsmentioning

confidence: 86%

“…The trial identified a mean of four administration times per day at baseline (standard deviation (SD) 1.8) among 242 participants, with 92 simplification opportunities identified for 62 of the 96 residents who received the intervention. We have previously shown a reduction in the number of administration times in the intervention arm at 4 months compared to the comparison arm (mean difference −0.36, 95%CI −0.63 to −0.09) [25]. No differences were observed between study arms in the rate of falls, hospitalizations or mortality at 4 month follow up.…”

Section: Introductionmentioning

confidence: 84%

“…Nutritional drinks, pro re nata (PRN, as required) or nurse-initiated medications, short-term therapies such as antimicrobials, or medications not administered daily were not considered when calculating the number of daily administration times. The same definition of regular medications was applied at 4 month follow up (primary SIMPLER study outcome) [25].…”

Section: Discussionmentioning

confidence: 99%

“…The pharmacist made 92 recommendations for 62 residents in the intervention arm (n = 65%). A comprehensive overview of the recommendations has been published elsewhere [25]. Briefly, the most common recommendation was to change the medication dose time (n = 60, 65.2%), followed by a change in formulation (n = 25, 27.2%).…”

Section: Demographicsmentioning

confidence: 99%

“…In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial (RCT), structured medication regimen simplification significantly reduced the number of daily medication administration times in the intervention arm at 4 months post-study entry [25]. Residents in the intervention arm received a structured medication simplification intervention using the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) [24,26].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

Sluggett

Hopkins

Chen

et al. 2020

JCM

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In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (−0.38, 95% confidence intervals (CI) −0.69 to −0.07) and 12 months (−0.47, 95%CI −0.84 to −0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57–5.53) or mortality (relative risk 0.81, 95%CI 0.48–1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement.

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Section: Resultsmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Demographicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

Sluggett

Hopkins

Chen

et al. 2020

JCM

Self Cite

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Optimising medication management during the COVID‐19 pandemic

Scott

Rigby

Hilmer

2020

Pharmacy Practice and Res

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The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

Liau

Lalic

Visvanathan

et al. 2021

The Journal of nutrition, health and aging

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Objectives To investigate frailty prevalence, cross-sectional associations, predictive validity, concurrent validity, and cross-cultural adaptations of the FRAIL-NH scale. Design Systematic review. Setting and Participants Frail residents living in nursing homes. Methods MEDLINE, EMBASE, CINAHL, and Cochrane Library were searched from January 2015 to June 2021 for primary studies that used the FRAIL-NH scale, irrespective of study designs and publication language. Results Overall, 40 studies conducted across 20 countries utilized the FRAIL-NH scale; majority in Australia (n=14), followed by China (n=6), United States (n=3), and Spain (n=3). The scale has been translated and back-translated into Brazilian Portuguese, Chinese, and Japanese. Various cut-offs have been used, with ≥2 and ≥6 being the most common cut-offs for frail and most frail, respectively. When defined using these cut-offs, frailty prevalence varied from 15.1–79.5% (frail) to 28.5–75.0% (most frail). FRAIL-NH predicted falls (n=2), hospitalization or length of stay (n=4), functional or cognitive decline (n=4), and mortality (n=9) over a median follow-up of 12 months. FRAIL-NH has been compared to 16 other scales, and was correlated with Fried’s phenotype (FP), Frailty Index (FI), and FI-Lab. Four studies reported fair-to-moderate agreements between FRAIL-NH and FI, FP, and the Comprehensive Geriatric Assessment. Ten studies assessed the sensitivity and specificity of different FRAIL-NH cutoffs, with ≥8 having the highest sensitivity (94.1%) and specificity (82.8%) for classifying residents as frail based on FI, while two studies reported an optimal cut-off of ≥2 based on FI and FP, respectively. Conclusion In seven years, the FRAIL-NH scale has been applied in 20 countries and adapted into three languages. Despite being applied with a range of cut-offs, FRAIL-NH was associated with higher care needs and demonstrated good agreement with other well-established but more complex scales. FRAIL-NH was predictive of adverse outcomes across different settings, highlighting its value in guiding care for frail residents in nursing homes. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-021-1694-3 and is accessible for authorized users.

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Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial

Cited by 20 publications

References 39 publications

Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

Optimising medication management during the COVID‐19 pandemic

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

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