The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study

Abstract

BackgroundMedication regimens in nursing home (NH) residents with severe dementia should be frequently reviewed to avoid inappropriate medication, overtreatment and adverse drug events, within a comfort care approach. This study aimed at testing the feasibility of an interdisciplinary knowledge exchange (KE) intervention using a medication review guidance tool categorizing medications as either “generally”, “sometimes” or “exceptionally” appropriate for NH residents with severe dementia.MethodsA quasi-experimental feasibility pilot study with 44 participating residents aged 65 years or over with severe dementia was carried out in three NH in Quebec City, Canada. The intervention comprised an information leaflet for residents’ families, a 90-min KE session for NH general practitioners (GP), pharmacists and nurses focusing on the medication review guidance tool, a medication review by the pharmacists for participating residents with ensuing team discussion on medication changes, and a post-intervention KE session to obtain feedback from team staff. Medication regimens and levels of pain and of agitation of the participants were evaluated at baseline and at 4 months post-intervention. A questionnaire for team staff explored perceived barriers and facilitators. Statistical differences in measures comparing pre and post-intervention were assessed using paired t-tests and Cochran’s-Q tests.ResultsThe KE sessions reached 34 NH team staff (5 GP, 4 pharmacists, 6 heads of care unit and 19 staff nurses). Forty-four residents participated in the study and were followed for a mean of 104 days. The total number of regular medications was 372 pre and 327 post-intervention. The mean number of regular medications per resident was 7.86 pre and 6.81 post-intervention. The odds ratios estimating the risks of using any regular medication or a “sometimes appropriate” medication post-intervention were 0.81 (95% CI: 0.71–0.92) and 0.83 (95% CI: 0.74–0.94), respectively.ConclusionA simple KE intervention using a medication review guidance tool categorizing medications as being either “generally”, “sometimes” or “exceptionally” appropriate in severe dementia was well received and accompanied by an overall reduction in medication use by NH residents with severe dementia. Levels of agitation were unaffected and there was no clinically significant changes in levels of pain. Staff feedback provided opportunities to improve the intervention.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0895-z) contains supplementary material, which is available to authorized users.

Pharmacist‐led medication reviews in aged care residents with dementia: A systematic review

“…54,55 Four of the studies [48][49][50][51] evaluated medication reviews conducted by visiting pharmacists, such as community pharmacists, who did not routinely participate in the care of the residents included in the studies. Two studies 47,52 evaluated interventions which included the usual pharmacists, physicians and RACF staff involved in participating resident care. This is important from a study design perspective, as the professional trust required to collaborate effectively in the medication review process was already established.…”

“…Interventions were categorised as either single or multi-faceted, where single-faceted interventions comprised a pharmacist-led medication review alone and multi-faceted interventions comprised a medication review in conjunction with other strategies (Table 3). Medication reviews were performed by a pharmacist in five studies, [48][49][50][51][52] or by a multi-disciplinary team including a pharmacist in one study. 47 Meta-analysis was not possible due to heterogeneity of included study designs, interventions and outcome measures.…”

“…Multi-faceted medication review interventions were evaluated in the remaining four studies, 47,48,50,52 summarised in Table 3. All multi-faceted interventions identified the pharmacist as the key provider of pharmaceutical information to lead the medication review component.…”

“…All four of the multi-faceted interventions included some form of education component in conjunction with the medication review. Three studies 47,48,52 included education for the multi-disciplinary team including pharmacists, nurses and physicians, and one study 50 included education for the RACF care staff only. One study also provided education to resident representatives or family members.…”

Impact of medication review via tele-expertise on unplanned hospitalizations at 3 months of nursing homes patients (TEM-EHPAD): study protocol for a randomized controlled trial

“…The combination of both an acceptability survey and a satisfaction survey, the latter of which uses a mixed-method (qualitative and quantitative) approach, is particularly innovative. Indeed, in similar previous projects, feasibility/ experience assessment was conducted using qualitative or quantitative methods alone [44,45], or focused solely on post-intervention evaluation [46,47]. Moreover, the WHO defines "acceptability to participants" as an essential ethical issue in study design [48].…”