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Sharma R, Mahajan N, Fadaleh SA, Patel H, Ivo J, Faisal S, Chang F, Lee L, Patel T. Medication Reviews and Clinical Outcomes in Persons with Dementia: A Scoping Review. PHARMACY 2023; 11:168. [PMID: 37888512 PMCID: PMC10609910 DOI: 10.3390/pharmacy11050168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Persons diagnosed with dementia are often faced with challenges related to polypharmacy and inappropriate medication use and could benefit from regular medication reviews. However, the benefit of such reviews has not been examined in this population. Therefore, the current scoping review was designed to identify the gaps in the current knowledge regarding the impact of medication reviews on the clinical outcomes in older adults with dementia. Relevant studies were identified by searching three databases (Ovid MEDLINE, Ovid EMBASE, and Scopus) from inception to January 2022 with a combination of keywords and medical subject headings. After the removal of duplicates and ineligible articles, 22 publications of the initial 8346 were included in this review. A total of 57 outcomes were identified, including those pertaining to the evaluation of medication use (n = 17), drug-related interventions (n = 11), drug-related problems (n = 10), dementia-related behavioral symptoms (n = 8), cost-effectiveness (n = 2), drug-related hospital admissions (n = 1), as well as outcomes classified as other (n = 7). Gaps identified through this scoping review included the paucity of studies measuring the impact of medication reviews on the medication management capacity and medication adherence, quality of life, and mortality.
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Affiliation(s)
- Rishabh Sharma
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Neil Mahajan
- Faculty of Health, Western University, 1151 Richmond St, London, ON N6A 5B9, Canada;
| | - Sarah Abu Fadaleh
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Hawa Patel
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Jessica Ivo
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Sadaf Faisal
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Feng Chang
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
| | - Linda Lee
- CFFM MINT Memory Clinic, 25 Joseph St, Kitchener, ON N2G 4X6, Canada;
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON N2J 0E2, Canada
- Department of Family Medicine, McMaster University, 100 Main St W 5th Floor, Hamilton, ON L8P 1H6, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON N2G 1C5, Canada; (R.S.); (S.A.F.); (H.P.); (J.I.); (S.F.); (F.C.)
- CFFM MINT Memory Clinic, 25 Joseph St, Kitchener, ON N2G 4X6, Canada;
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON N2J 0E2, Canada
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Rommerskirch-Manietta M, Manietta C, Purwins D, Braunwarth JI, Quasdorf T, Roes M. Mapping implementation strategies of evidence-based interventions for three preselected phenomena in people with dementia-a scoping review. Implement Sci Commun 2023; 4:104. [PMID: 37641142 PMCID: PMC10463361 DOI: 10.1186/s43058-023-00486-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caring for people with dementia is complex, and there are various evidence-based interventions. However, a gap exists between the available interventions and how to implement them. The objectives of our review are to identify implementation strategies, implementation outcomes, and influencing factors for the implementation of evidence-based interventions that focus on three preselected phenomena in people with dementia: (A) behavior that challenges supporting a person with dementia in long-term care, (B) delirium in acute care, and (C) postacute care needs. METHODS We conducted a scoping review according to the description of the Joanna Briggs Institute. We searched MEDLINE, CINAHL, and PsycINFO. For the data analysis, we conducted deductive content analysis. For this analysis, we used the Expert Recommendations for Implementation Change (ERIC), implementation outcomes according to Proctor and colleagues, and the Consolidated Framework for Implementation Research (CFIR). RESULTS We identified 362 (A), 544 (B), and 714 records (C) on the three phenomena and included 7 (A), 3 (B), and 3 (C) studies. Among the studies, nine reported on the implementation strategies they used. Clusters with the most reported strategies were adapt and tailor to context and train and educate stakeholders. We identified one study that tested the effectiveness of the applied implementation strategy, while ten studies reported implementation outcomes (mostly fidelity). Regarding factors that influence implementation, all identified studies reported between 1 and 19 factors. The most reported factors were available resources and the adaptability of the intervention. To address dementia-specific influencing factors, we enhanced the CFIR construct of patient needs and resources to include family needs and resources. CONCLUSIONS We found a high degree of homogeneity across the different dementia phenomena, the evidence-based interventions, and the care settings in terms of the implementation strategies used, implementation outcomes measured, and influencing factors identified. However, it remains unclear to what extent implementation strategies themselves are evidence-based and which intervention strategy can be used by practitioners when either the implementation outcomes are not adjusted to the implementation strategy and/or the effects of implementation strategies are mostly unknown. Future research needs to focus on investigating the effectiveness of implementation strategies for evidence-based interventions for dementia care. TRIAL REGISTRATION The review protocol was prospectively published (Manietta et al., BMJ Open 11:e051611, 2021).
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Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany.
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Daniel Purwins
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Jana Isabelle Braunwarth
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Tina Quasdorf
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
- School of Health Science, Institute of Nursing, ZHAW Zürich University of Applied Science, Winterthur, Switzerland
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Keetharuth AD, Hussain H, Rowen D, Wailoo A. Assessing the psychometric performance of EQ-5D-5L in dementia: a systematic review. Health Qual Life Outcomes 2022; 20:139. [PMID: 36171595 PMCID: PMC9520934 DOI: 10.1186/s12955-022-02036-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND EQ-5D is widely used for valuing changes in quality of life for economic evaluation of interventions for people with dementia. There are concerns about EQ-5D-3L in terms of content validity, poor inter-rater agreement and reliability in the presence of cognitive impairment, but there is also evidence to support its use with this population. An evidence gap remains regarding the psychometric properties of EQ-5D-5L. OBJECTIVES To report psychometric evidence around EQ-5D-5L in people with dementia. METHODS A systematic review identified primary studies reporting psychometric properties of EQ-5D-5L in people with dementia. Searches were completed up to November 2020. Study selection, data extraction and quality assessment were undertaken independently by at least 2 researchers. RESULTS Evidence was extracted from 20 articles from 14 unique studies covering a range of dementia severity. Evidence of known group validity from 5 of 7 studies indicated that EQ-5D-5L distinguishes severity of disease measured by cognitive impairment, depression, level of dependence and pain. Convergent validity (9 studies) showed statistically significant correlations of weak and moderate strengths, between EQ-5D-5L scores and scores on other key measures. Statistically significant change was observed in only one of 6 papers that allowed this property to be examined. All seven studies showed a lack of inter-rater reliability between self and proxy reports with the former reporting higher EQ-5D-5L scores than those provided by proxies. Five of ten studies found EQ-5D-5L to be acceptable, assessed by whether the measure could be completed by the PwD and/or by the amount of missing data. As dementia severity increased, the feasibility of self-completing EQ-5D-5L decreased. Three papers reported on ceiling effects, two found some evidence in support of ceiling effects, and one did not. CONCLUSIONS EQ-5D-5L seems to capture the health of people with dementia on the basis of known-group validity and convergent validity, but evidence is inconclusive regarding the responsiveness of EQ-5D-5L. As disease progresses, the ability to self-complete EQ-5D-5L is diminished.
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Affiliation(s)
- Anju D Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, S14DA, UK.
| | - Hannah Hussain
- School of Health and Related Research, University of Sheffield, Sheffield, S14DA, UK
| | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, S14DA, UK
| | - Allan Wailoo
- School of Health and Related Research, University of Sheffield, Sheffield, S14DA, UK
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Structured Interventions to Optimize Polypharmacy in Psychiatric Treatment and Nursing Homes: A Systematic Review. J Clin Psychopharmacol 2022; 42:169-187. [PMID: 35230048 DOI: 10.1097/jcp.0000000000001521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Polypharmacy is a common clinical issue. It increases in prevalence with older age and comorbidities of patients and has been recognized as a major cause for treatment complications. In psychiatry, polypharmacy is also commonly seen in younger patients and can lead to reduced treatment satisfaction and incompliance. A variety of structured polypharmacy interventions have been investigated. This systematic review provides a comprehensive overview of the field and identifies research gaps. METHODS We conducted a systematic review on structured interventions aimed at optimizing polypharmacy of psychotropic and somatic medication in psychiatric inpatient and outpatient settings as well as nursing homes. A search protocol was registered with PROSPERO (CRD42020187304). Data were synthesized narratively. RESULTS Fifty-eight studies with a total of 30,554 participants met the inclusion criteria. Interventions were most commonly guided by self-developed or national guidelines, drug assessment scores, and lists of potentially inappropriate medications. Tools to identify underprescribing were less commonly used. Most frequently reported outcomes were quantitative drug-related measures; clinical outcomes such as falls, hospital admission, cognitive status, and neuropsychiatric symptom severity were reported less commonly. Reduction of polypharmacy and improvement of medication appropriateness were shown by most studies. CONCLUSIONS Improvement of drug-related outcomes can be achieved by interventions such as individualized medication review and educational approaches in psychiatric settings and nursing homes. Changes in clinical outcomes, however, are often nonsubstantial and generally underreported. Patient selection and intervention procedures are highly heterogeneous. Future investigations should establish standards in intervention procedures, identify and assess patient-relevant outcome measures, and consider long-term follow-up assessments.
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Massot Mesquida M, Folkvord F, Seda G, Lupiáñez-Villanueva F, Torán Monserrat P. Cost-utility analysis of a consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients. BMC Geriatr 2021; 21:327. [PMID: 34022809 PMCID: PMC8141120 DOI: 10.1186/s12877-021-02287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Growing evidence shows the effects of psychotropic drugs on the evolution of dementia. Until now, only a few studies have evaluated the cost-effectiveness of psychotropic drugs in institutionalized dementia patients. This study aims to assess the cost-utility of intervention performed in the metropolitan area of Barcelona (Spain) (MN) based on consensus between specialized caregivers involved in the management of dementia patients for optimizing and potentially reducing the prescription of inappropriate psychotropic drugs in this population. This analysis was conducted using the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) tool. METHODS The MAFEIP tool builds up from a variety of surrogate endpoints commonly used across different studies in order to estimate health and economic outcomes in terms of incremental changes in quality adjusted life years (QALYs), as well as health and social care utilization. Cost estimates are based on scientific literature and expert opinion; they are direct costs and include medical visits, hospital care, medical tests and exams and drugs administered, among other concepts. The healthcare costs of patients using the intervention were calculated by means of a medication review that compared patients' drug-related costs before, during and after the use of the intervention conducted in MN between 2012 and 2014. The cost-utility analysis was performed from the perspective of a health care system with a time horizon of 12 months. RESULTS The tool calculated the incremental cost-effectiveness ratio (ICER) of the intervention, revealing it to be dominant, or rather, better (more effective) and cheaper than the current (standard) care. The ICER of the intervention was in the lower right quadrant, making it an intervention that is always accepted even with the lowest given Willingness to Pay (WTP) threshold value (€15,000). CONCLUSIONS The results of this study show that the intervention was dominant, or rather, better (more effective) and cheaper than the current (standard) care. This dominant intervention is therefore recommended to interested investors for systematic application.
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Affiliation(s)
- Mireia Massot Mesquida
- Servei d'Atenció Primària Vallès Occidental, Direcció d'Atenció Primària Metropolitana Nord. Institut Català de la Salut. Sabadell, Barcelona, Spain. .,Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), accredited by AGAUR (2017 SGR 917), Barcelona, Spain.
| | - Frans Folkvord
- Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, The Netherlands.,Open Evidence Research, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Gemma Seda
- Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), accredited by AGAUR (2017 SGR 917), Barcelona, Spain.,Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Barcelona, Spain
| | - Francisco Lupiáñez-Villanueva
- Open Evidence Research, Universitat Oberta de Catalunya, Barcelona, Spain.,Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Pere Torán Monserrat
- Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), accredited by AGAUR (2017 SGR 917), Barcelona, Spain.,Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Barcelona, Spain
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Langford AV, Ngo GT, Chen TF, Roberts C, Schneider CR. Nurses', Pharmacists' and Family Physicians' Perceptions of Psychotropic Medication Monitoring in Australian Long-Term Care Facilities: A Qualitative Framework Analysis. Drugs Aging 2020; 38:169-179. [PMID: 33314009 DOI: 10.1007/s40266-020-00825-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current evidence suggests that despite modest benefit in using targeted psychotropic medications in the geriatric population, there is significant iatrogenic morbidity and mortality. Monitoring of the use of psychotropic medications by health care professionals (HCPs) to reduce adverse effects is often suboptimal; however, there have been few theoretically informed studies as to why this is so. OBJECTIVE This study aimed to elucidate facilitators and barriers to psychotropic medication monitoring in long-term care facilities (LTCFs) from the viewpoint of nurses, pharmacists and family physicians. Secondly, it intended to identify targets for tailored intervention strategies to improve monitoring practices. METHODS A purposive sample of 31 HCPs working in LTCFs in Sydney, New South Wales, Australia was recruited. Three cohorts consisted of twelve registered nurses, ten pharmacists and nine family physicians. Semi-structured interviews were conducted, assessing perceptions of psychotropic medication monitoring in LTCFs, facilitators, barriers and proposed solutions. Interviews were transcribed verbatim and thematically analyzed through an inductive coding approach. Themes were then mapped to Ferlie and Shortell's 'Four Levels of Change' framework for improving quality in healthcare. RESULTS Monitoring was revealed as a multi-faceted concept, influenced by factors across individual, group, organization and system levels. Thematic analysis revealed six key themes pertinent to psychotropic monitoring in LTCFs: (1) engagement with monitoring, (2) monitoring capability, (3) opportunity to monitor, (4) roles and responsibilities, (5) communication and collaboration and (6) guidance and regulation. HCPs conceptualized monitoring differently, but consistently felt that monitoring in LTCFs was suboptimal, recognizing a need for guidance and resources to aid collaborative monitoring of psychotropic medications. HCPs internally situated within LTCFs (nurses) viewed psychotropic medication monitoring as a dynamic and ongoing phenomenon, occurring both formally and informally on a day-to-day basis. In contrast, externally situated HCPs (pharmacists and family physicians) typically associated medication monitoring with structured medication reviews and conceptualized monitoring as an intermittent and planned activity. CONCLUSIONS AND IMPLICATIONS Psychotropic monitoring is perceived by all HCPs as a shared responsibility; however, the conceptualization of monitoring differs between HCPs. HCPs' beliefs and attitudes require consideration when designing implementation strategies for interventions to ameliorate suboptimal monitoring practices.
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Affiliation(s)
- Aili V Langford
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Garzee Tracy Ngo
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Chris Roberts
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Carl R Schneider
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Campbell N, Maidment ID, Randle E, Shaw RL. Preparing care home staff to manage challenging behaviours among residents living with dementia: A mixed-methods evaluation. Health Psychol Open 2020; 7:2055102920933065. [PMID: 35186309 PMCID: PMC8851137 DOI: 10.1177/2055102920933065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We evaluated an intervention designed to manage challenging behaviours of people
with dementia. Framework analysis of interviews (n = 21) showed
the intervention modified practice and perceptions. The intervention
(n = 58; power calculation proposed
n = 160 for medium effect) had no significant effect on
attitudes to dementia for time (p = .42) or care home
(p = .15). The Maslach burnout scores did not change
significantly for person-centredness for time (p = .83) or care
home (p = .29). Hope scores showed a significant effect
post-intervention (p = .004), but this was not maintained. No
significant main effect was found for care home (p = .36).
Experiential learning enabled staff to experience benefits of person-centred
care firsthand.
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Affiliation(s)
| | | | | | - Rachel L Shaw
- Aston University, UK
- Rachel L Shaw, School of Psychology, College
of Health & Life Sciences, Aston University, Birmingham B4 7ET, UK.
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