Medication Management Models for Polymedicated Home-Dwelling Older Adults With Multiple Chronic Conditions: Protocol of a Systematic Review

Background

Older adults with multiple chronic diseases commonly require complex medication regimes. When combined with frailty, cognitive impairment, and changing pharmacological prescriptions, older adults’ polymedication regimes increase the risk of medication-related problems (MRPs) and hospitalization. Effective, well-organized medication management could avoid MRPs and their clinical outcomes.

Objective

Identify medication management models and analyze their impact on managing and preventing MRPs for polymedicated, home-dwelling older adults.

Methods

We will conduct a systematic review of published articles in relevant professional scientific journals from inception until March 31, 2019, in the following electronic databases,: Embase; Medline OvidSP; PubMed (NOT Medline[sb]); Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO; PsycINFO OvidSP; Cochrane Library, Wiley; and Web of Science. We will also hand search the bibliographies of all the relevant articles found and search for unpublished studies. We will consider publications in English, French, German, Spanish, Italian, and Portuguese. Retrieved articles will be screened for eligibility. Statistical analyses will be conducted following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statements. Data will be analyzed using SPSS Statistics for Windows, version 25.0 (IBM Corp), and Review Manager, version 5.5 (The Nordic Cochrane Centre, The Cochrane Collaboration).

Results

A preliminary search in Embase delivered 3272 references. This preliminary search allows us to complete our research strategy with equation development and to search the other databases. Relevant articles identified will allow for searching the reference lists for unpublished studies. The inclusion and exclusion criteria will be rigorously respected in the study selection. The entire study is expected to be completed by January 2020.

Conclusions

This review will provide an exhaustive view of medication management models that could be effective for polymedicated, home-dwelling older adults and will allow us to analyze their impact on managing and preventing MRPs.

Trial Registration

PROSPERO CRD42018117287; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=117287 (Archived by WebCite at http://www.webcitation.org/77fCfbCjT)

International Registered Report Identifier (IRRID)

DERR1-10.2196/13582

From Hospital to Home and Back Again: A Study in Hospital Admissions and Deaths for Home Care Patients

In this study, the authors examined causes of deaths or hospitalizations of adult home care patients during an 18-month period using a retrospective medical record audit. The site of the study was the home care program of a three-hospital system. Of 4,303 cases, 101 adult patients met study criteria of hospitalization or death. The death rate in the sample was 0.48%, and the hospitalization rate was 1.9%. Wound deterioration and falling accidents were principal causes for rehospitalizing patients. Increasing age and number of medications were significantly correlated with falls resulting in hospitalization. Patients who died were found to suffer from terminal illnesses and frailty, with care providers having little influence over outcomes. Opportunities to improve clinical care processes (e.g., discharge planning, patient status monitoring, signs and symptoms reporting, interdisciplinary communicating and coordinating) were also identified. The authors concluded that nearly 21% of hospitalizations were potentially preventable.

Adverse events experienced by homecare patients: a scoping review of the literature

PURPOSE

The paper summarizes the results of a scoping review that focused on the occurrence of adverse events experienced by homecare patients.

DATA SOURCES

The literature search covered published and grey literature between 1998 and 2007. Databases searched included: MEDLINE, EMBASE, CINAHL and EBM REVIEWS including the Cochrane Library, AGELINE, the National Patient Safety Foundation Bibliography, Agency for Healthcare Research and Quality and the Patient Safety Net bibliography.

STUDY SELECTION

Papers included research studies, review articles, policy papers, opinion articles and legal briefs. Inclusion criteria were: (i) homecare directed services provided in the home by healthcare professionals or caregivers; (ii) addressed a characteristic relevant to patient experienced adverse events (e.g. occurrences, rates, definitions, prevention or outcomes); and (iii) were in English. Data extraction A pool of 1007 articles was reduced to 168 after analysis. Data were charted according to six categories: definitions, rates, causes, consequences, interventions and policy.

RESULTS

Eight categories emerged: adverse drug events, line-related, technology-related, infections and urinary catheters, wounds, falls, studies reporting multiple rates and other. Reported overall rates of adverse events ranged from 3.5 to 15.1% with higher rates for specific types. Few intervention studies were found. Adverse events were commonly associated with communication problems. Policy suggestions included the need to improve assessments, monitoring, education, coordination and communication.

CONCLUSION

A standardized definition of adverse events in the homecare setting is needed. Prospective cohort studies are needed to improve estimates and intervention studies should be undertaken to reduce the risk that homecare patients will experience adverse events.