1
|
Falconer N, Scott IA, Abdel-Hafez A, Cottrell N, Long D, Morris C, Snoswell C, Aziz E, Jie Lam JY, Barras M. The adverse inpatient medication event and frailty (AIME-frail) risk prediction model. Res Social Adm Pharm 2024; 20:796-803. [PMID: 38772838 DOI: 10.1016/j.sapharm.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/04/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Medication harm affects between 5 and 15% of hospitalised patients, with approximately half of the harm events considered preventable through timely intervention. The Adverse Inpatient Medication Event (AIME) risk prediction model was previously developed to guide a systematic approach to patient prioritisation for targeted clinician review, but frailty was not tested as a candidate predictor variable. AIM To evaluate the predictive performance of an updated AIME model, incorporating a measure of frailty, when applied to a new multisite cohort of hospitalised adult inpatients. METHODS A retrospective cohort study was conducted at two tertiary Australian hospitals on patients discharged between 1st January and April 31, 2020. Data were extracted from electronic medical records (EMRs) and clinical coding databases. Medication harm was identified using ICD-10 Y-codes and confirmed by senior pharmacist review of medical records. The Hospital Frailty Risk Score (HFRS) was calculated for each patient. Logistic regression analysis was used to construct a modified AIME model. Candidate variables of the original AIME model, together with new variables including HFRS were tested. Performance of the final model was reported using area under the curve (AUC) and decision curve analysis (DCA). RESULTS A total of 4089 patient admissions were included, with a mean age ± standard deviation (SD) of 64 years (±19 years), 2050 patients (50%) were males, and mean HFRS was 6.2 (±5.9). 184 patients (4.5%) experienced one or more medication harm events during hospitalisation. The new AIME-Frail risk model incorporated 5 of the original variables: length of stay (LOS), anti-psychotics, antiarrhythmics, immunosuppressants, and INR greater than 3, as well as 5 new variables: HFRS, anticoagulants, antibiotics, insulin, and opioid use. The AUC was 0.79 (95% CI: 0.76-0.83) which was superior to the original model (AUC = 0.70, 95% CI: 0.65-0.74) with a sensitivity of 69%, specificity of 81%, positive predictive value of 0.14 (95% CI: 0.10-0.17) and negative predictive value of 0.98 (95% CI: 0.97-0.99). The DCA identified the model as having potential clinical utility between the probability thresholds of 0.05-0.4. CONCLUSION The inclusion of a frailty measure improved the predictive performance of the AIME model. Screening inpatients using the AIME-Frail tool could identify more patients at high-risk of medication harm who warrant timely clinician review.
Collapse
Affiliation(s)
- Nazanin Falconer
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, 199 Ipswich Road, Brisbane, QLD, 4102, Australia; School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia; UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4102, Australia.
| | - Ian A Scott
- Department of Internal Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Ahmad Abdel-Hafez
- Clinical Informatics, Metro South Health, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia; University of Doha for Science and Technology, Doha, Qatar
| | - Neil Cottrell
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Duncan Long
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, 199 Ipswich Road, Brisbane, QLD, 4102, Australia
| | - Christopher Morris
- Department of Internal Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Centaine Snoswell
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia; UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Ebtyhal Aziz
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia; Logan Hospital, Armstrong Rd and Loganlea Rd, Meadowbrook, Queensland QLD, 4131, Australia
| | - Jonathan Yong Jie Lam
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, 199 Ipswich Road, Brisbane, QLD, 4102, Australia; School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Michael Barras
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, 199 Ipswich Road, Brisbane, QLD, 4102, Australia; School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, 4102, Australia
| |
Collapse
|
2
|
Andrade A, Nascimento T, Cabrita C, Leitão H, Pinto E. Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults. Healthcare (Basel) 2024; 12:1275. [PMID: 38998810 PMCID: PMC11241476 DOI: 10.3390/healthcare12131275] [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: 05/18/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population.
Collapse
Affiliation(s)
- Amanda Andrade
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Tânia Nascimento
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
| | - Catarina Cabrita
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Helena Leitão
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal
| | - Ezequiel Pinto
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
| |
Collapse
|
3
|
Miller J, Bee A, Pattison D, Walker M, Aldridge E, Hackett L, Owen PJ, Marangon-Elliott R, Buntine P. Managing falls onsite in residential aged care homes reduced hospitalisation: Mixed methods results from the Falls Outreach and Residential Mobile Assessment Team (FORMAT) pilot study. Australas J Ageing 2024. [PMID: 38932520 DOI: 10.1111/ajag.13336] [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: 10/10/2023] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Falls are the leading cause of hospital transfer from residential aged care homes (RACHs). However, many falls do not result in significant injury, and ageing patients are exposed to complications while hospitalised. Inreach services are designed to reduce hospital transfer by providing care, support and assessment to residents at the RACH. This study evaluated a pilot inreach program targeting ageing patients following a fall. METHODS We conducted a prospective, mixed methods evaluation of a 5-month (May-September 2022) pilot implementation across 108 government-funded RACHs within a single health-care network in Melbourne, Australia. RESULTS A total of 123 residents (median [interquartile range] age: 88 [82, 94] years, female: 49%) were included in the intervention. The majority (n = 116, 94%) of residents were managed onsite and required no further investigation (n = 80, 69%) or treatment (n = 63, 54%). Among the seven residents referred to the emergency department (ED), two received hospital admission and five were transferred back to residential care. In the 7 days following referral to the intervention, four additional residents were referred to the ED and one received hospital admission. Qualitative feedback (n = 40) included specific comments relating to themes of general satisfaction (n = 20, 50%), compliments for staff (n = 16, 40%) and acknowledgement of comprehensiveness (n = 9, 23%). CONCLUSIONS Implementation of a specialised fall assessment team to complement an existing geriatric-led RACH assessment service meant that a high rate of eligible residents were managed onsite, with very low need for subsequent hospitalisation. Residents, family members and caregivers expressed high rates of satisfaction with the service.
Collapse
Affiliation(s)
- Joseph Miller
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
| | - Andrea Bee
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Donna Pattison
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Megan Walker
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Emogene Aldridge
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
| | - Liam Hackett
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
| | - Patrick J Owen
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
| | | | - Paul Buntine
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
| |
Collapse
|
4
|
Quinn J, Bodenstab HM, Wo E, Parrish RH. Medication Management Through Collaborative Practice for Children With Medical Complexity: A Prospective Case Series. J Pediatr Pharmacol Ther 2024; 29:119-129. [PMID: 38596413 PMCID: PMC11001202 DOI: 10.5863/1551-6776-29.2.119] [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: 06/27/2023] [Accepted: 11/08/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Care coordination for children and youth with special health care needs and medical complexity (CYSHCN-CMC), especially medication management, is difficult for providers, parents/caregivers, and -patients. This report describes the creation of a clinical pharmacotherapy practice in a pediatric long-term care facility (pLTCF), application of standard operating procedures to guide comprehensive medication management (CMM), and establishment of a collaborative practice agreement (CPA) to guide drug therapy. METHODS In a prospective case series, 102 patients characterized as CYSHCN-CMC were included in this pLTCF quality improvement project during a 9-month period. RESULTS Pharmacists identified, prevented, or resolved 1355 drug therapy problems (DTP) with an average of 13 interventions per patient. The patients averaged 9.5 complex chronic medical conditions with a -median length of stay of 2815 days (7.7 years). The most common medications discontinued due to pharmacist assessment and recommendation included diphenhydramine, albuterol, sodium phosphate enema, ipratropium, and metoclopramide. The average number of medications per patient was reduced from 23 to 20. A pharmacoeconomic analysis of 244 of the interventions revealed a monthly direct cost savings of $44,304 ($434 per patient per month) and monthly cost avoidance of $48,835 ($479 per patient per month). Twenty-eight ED visits/admissions and 61 clinic and urgent care visits were avoided. Hospital -readmissions were reduced by 44%. Pharmacist recommendations had a 98% acceptance rate. CONCLUSIONS Use of a CPA to conduct CMM in CYSHCN-CMC decreased medication burden, resolved, and prevented adverse events, reduced health care-related costs, reduced hospital readmissions and was well-accepted and implemented collaboratively with pLTCF providers.
Collapse
Affiliation(s)
- Jena Quinn
- Perfecting Peds (JQ, HMB, EW), Haddon Heights, NJ
| | - Heather Monk Bodenstab
- Perfecting Peds (JQ, HMB, EW), Haddon Heights, NJ
- Medical Affairs (HMB), Sobi, Waltham, MA
| | - Emily Wo
- Perfecting Peds (JQ, HMB, EW), Haddon Heights, NJ
| | | |
Collapse
|
5
|
Rachmawaty R, Wahyudin E, Bukhari A, Sinrang AW, Satar GL, Juhran A. Healthcare Quality Received by Insured Patients in Two Indonesian Regional Public Hospitals. J Holist Nurs 2024:8980101241229481. [PMID: 38311909 DOI: 10.1177/08980101241229481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Background: Hospitals are required to improve the quality of health services provided to patients. Purpose: Evaluating and comparing the healthcare quality received by insured patients hospitalized in two Indonesian regional public hospitals. Methods: Secondary data analysis used the 2019 and 2020 Indonesian National Health Insurance e-claim databases of Hospital A and Hospital B. Descriptive and crosstabs analyses were used to determine INA-CBGs diagnoses that were categorized as high volume, high risk, and high cost. Results: The admissions that caused financial loss at the Hospital A were 21.1% in 2019 and 19.8% in 2020, while 30.3% in 2019 and 27.5% at the Hospital B. More than 60% of these admissions were placed in the 3rd class of inpatient wards of the two hospitals. Of these admissions, < 5% at the Hospital A and >5% at the Hospital B were readmitted within 30 days, although more than 90% were previously discharged based on physicians' approval. Conclusions: Inadequate healthcare quality received by insured patients. Hence, an integrated clinical pathways based professional nursing practice model is highly recommended to increase patient outcomes and decrease 30 days hospital readmission rates.
Collapse
|
6
|
Malouh MA, Sefidani Forough A, Cichero JAY, Lau ETL, Nissen LM, Steadman KJ. The prevalence and perceived effectiveness of using a medication-swallowing lubricant in aged care facilities across Australia. Aging Med (Milton) 2023; 6:239-244. [PMID: 37711253 PMCID: PMC10498827 DOI: 10.1002/agm2.12261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 09/16/2023] Open
Abstract
Objective To explore the extent of use and perceived effectiveness of using a medication lubricant that is specifically designed to help people who struggle to swallow their solid medications whole. Method Health care workers of varying professional levels in aged care facilities (ACFs) across Australia who are involved in medication administration were invited to participate in a structured online survey. Results Of the 355 health care workers who completed the survey, 48% had used the medication lubricant to aid administration of whole and/or crushed solid oral dosage forms, and of these 89% agreed with the statement that "it is effective method to facilitate medication swallowing in residents." The main benefits of using the medication lubricant were considered to be easier medication administration to residents (49%), reduction in need for crushing of medications (34%), and better adherence with medications (33%). Conclusions This study showed that using a medication lubricant for aged care residents may facilitate the process of medication administration for health care workers, which they perceive to improve residents' adherence with medications. Serious complications associated with solid dosage form modification may also be decreased by using a medication lubricant, as the need for modifying medications is reduced. Therapeutic Goods Administration (TGA)-approved medication lubricants could therefore be a valuable tool to aid the medication administration for patients who have difficulties swallowing medications. Future research may consider the clinical efficacy and acceptability of medication lubricants specifically for people with swallowing difficulties.
Collapse
Affiliation(s)
- Marwa A. Malouh
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
| | - Aida Sefidani Forough
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Julie A. Y. Cichero
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Esther T. L. Lau
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Lisa M. Nissen
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Kathryn J. Steadman
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| |
Collapse
|
7
|
Mbous YPV, Brothers T, Al-Mamun MA. Medication Regimen Complexity Index Score at Admission as a Predictor of Inpatient Outcomes: A Machine Learning Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3760. [PMID: 36834454 PMCID: PMC9967355 DOI: 10.3390/ijerph20043760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In the intensive care unit, traditional scoring systems use illness severity and/or organ failure to determine prognosis, and this usually rests on the patient's condition at admission. In spite of the importance of medication reconciliation, the usefulness of home medication histories as predictors of clinical outcomes remains unexplored. METHODS A retrospective cohort study was conducted using the medical records of 322 intensive care unit (ICU) patients. The predictors of interest included the medication regimen complexity index (MRCI) at admission, the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Sequential Organ Failure Assessment (SOFA) score, or a combination thereof. Outcomes included mortality, length of stay, and the need for mechanical ventilation. Machine learning algorithms were used for outcome classification after correcting for class imbalances in the general population and across the racial continuum. RESULTS The home medication model could predict all clinical outcomes accurately 70% of the time. Among Whites, it improved to 80%, whereas among non-Whites it remained at 70%. The addition of SOFA and APACHE II yielded the best models among non-Whites and Whites, respectively. SHapley Additive exPlanations (SHAP) values showed that low MRCI scores were associated with reduced mortality and LOS, yet an increased need for mechanical ventilation. CONCLUSION Home medication histories represent a viable addition to traditional predictors of health outcomes.
Collapse
Affiliation(s)
- Yves Paul Vincent Mbous
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA
| | - Todd Brothers
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI 02881, USA
- Roger Williams Medical Center, Providence, RI 02908, USA
| | - Mohammad A. Al-Mamun
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA
| |
Collapse
|
8
|
Changes in medication regimen complexity index following medication-related hospital admissions: A retrospective single-centre study. Res Social Adm Pharm 2023; 19:969-972. [PMID: 36870817 DOI: 10.1016/j.sapharm.2023.02.011] [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: 07/01/2022] [Revised: 01/31/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Medication-related hospitalisations present an opportunity for de-prescribing and simplification of medication regimens. The Medication Regimen Complexity Index (MRCI) is a tool for measuring the complexity of medication regimens. OBJECTIVES To evaluate whether MRCI changes following medication-related hospitalisations, and to evaluate the relationship between MRCI, length of stay (LOS) in hospital, and patient characteristics. METHODS A retrospective medical record review of patients admitted to a tertiary referral hospital in Australia for medication-related problems, January 2019 to August 2020. MRCI was calculated using pre-admission medication lists and discharge medication lists. RESULTS There were 125 patients who met inclusion criteria. The median (IQR) age was 64.0 years (45.0-75.0) and 46.4% were female. Median MRCI decreased by 2.0 following hospitalisation: from median (IQR) 17.0 (7.0-34.5) on admission vs 15.0 (3.0-29.0) on discharge (p < 0.001). Admission MRCI predicted LOS ≥2 days (OR 1.03, 95%CI 1.00-1.05, p = 0.022). Allergic reaction-related hospitalisations were associated with lower admission MRCI. CONCLUSIONS There was a decrease in MRCI following medication-related hospitalisation. Targeted medication reviews for high-risk patients (e.g., those with medication-related hospitalisations) could further reduce the burden of medication complexity following discharge from hospital and possibly prevent readmissions.
Collapse
|
9
|
Page AT, Potter K, Naganathan V, Hilmer S, McLachlan AJ, Lindley RI, Coman T, Mangin D, Etherton-Beer C. Polypharmacy and medicine regimens in older adults in residential aged care. Arch Gerontol Geriatr 2023; 105:104849. [PMID: 36399891 DOI: 10.1016/j.archger.2022.104849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe medicines regimens used by older people living in residential aged care facilities (RACFs). MATERIALS AND METHODS This cross-sectional study presents baseline data from a randomised controlled trial in seventeen Australian RACFs that recruited residents aged 65 years and older at the participating facilities. The main outcome measures were to evaluation of medicines utilisation, including the number of medicines, medicine regimen complexity, potential under-prescribing and high-risk prescribing (prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines) with data analysed descriptively. RESULTS Medicines regimens were analysed for 303 residents (76% female) with a mean age of 85.0 ± 7.5 years, of whom the majority were living with dementia (72%). Residents were prescribed an average of 10.3 ± 4.5 regular medicines daily. Most participants (85%) had highly complex regimens. Most residents (92%) were exposed to polypharmacy (five or more medicines). Nearly all, 302 (98%) residents had at least one marker of potentially suboptimal prescribing. At least one instance of potential under-prescribing was identified in 86% of residents. At least one instance of high-risk prescribing was identified in 81% of residents including 16% of participants with at least one potential prescribing cascade. CONCLUSION(S) Potentially suboptimal prescribing affected almost all residents in this study, and most had highly complex medicines regimens. If generalisable, these findings indicate most older people in RACFs may be at risk of medicines-related harm from suboptimal prescribing, in addition to the burden of administration of complex medicines regimens for facility staff and residents.
Collapse
Affiliation(s)
- Amy Theresa Page
- Centre for Optimisation of Medicines, School of Allied Health, The University of Western Australia, Crawley, Western Australia, Australia; WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia.
| | | | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Hilmer
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Andrew J McLachlan
- ydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Richard I Lindley
- University of Sydney, Sydney, Australia and the George Institute for Global Health, Sydney, Australia
| | - Tracy Coman
- Menzies Health Institute Queensland, Griffith University, University Drive Meadowbrook, Brisbane, Queensland, Australia
| | | | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
| |
Collapse
|
10
|
Nissan R, Gezin I, Baha M, Gomon T, Hershkovitz A. Medication regimen complexity index and rehabilitation outcomes in post-acute hip fracture patients study: a retrospective study. Int J Clin Pharm 2022; 44:1361-1369. [PMID: 36198839 DOI: 10.1007/s11096-022-01442-3] [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: 01/17/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Polypharmacy is a common problem amongst the elderly population. The complexity of the drug regimen refers not only to a simple medication count, but also to the number of daily doses, frequency, and special instructions given for their use. Medication regimen complexity may affect health outcomes, including an increase in hospitalization rates, drug non-adherence, and mortality rates. AIM To assess whether the admission medication regimen complexity index score is associated with rehabilitation outcomes in hip fracture patients; secondary- to assess whether changes in the medication regimen complexity index scores during rehabilitation are associated with rehabilitation outcomes. METHOD A retrospective study of 336 hip fracture patients admitted to a post-acute rehabilitation hospital. Primary rehabilitation outcome was assessed via the discharge functional independence measure score. Secondary outcomes included functional independence measure score changes, length of stay and discharge destination. RESULTS Patients with low admission medication regimen complexity index scores attained significantly higher admission and discharge motor functional independence measure scores (40.1 vs. 37.1, p = 0.044; 57.1 vs. 52.9, p = 0.014, respectively), a higher motor functional independence measure score effectiveness (36.1 vs. 31.3, p = 0.030) and a higher rate of favorable motor functional independence measure effectiveness score (58.1% vs. 42.0%, p = 0.004). A multiple linear regression analysis revealed that the admission medication regimen complexity index score was not associated with the discharge functional independence measure score (standardized coefficient = - 0.058; p = 0.079). CONCLUSION A high medication regimen complexity which usually implies severe comorbidity should not be considered a barrier for the rehabilitation of older patients.
Collapse
Affiliation(s)
- Ran Nissan
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Irridea Gezin
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Michael Baha
- Rehabilitation Ward, Loewenstein Hospital Rehabilitation Center, Ra'anana, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tamara Gomon
- Rehabilitation Ward, Loewenstein Hospital Rehabilitation Center, Ra'anana, Israel
| | - Avital Hershkovitz
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| |
Collapse
|
11
|
Bell J, Ooi CE, Troeung L, Craik S, Walton R, Martini A. Protocol for a pilot and feasibility study of nurse practitioner-pharmacist telehealth collaboration to simplify complex medication regimens. Res Social Adm Pharm 2022; 18:3687-3693. [DOI: 10.1016/j.sapharm.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
|
12
|
Koria LG, Sawan MJ, Redston MR, Gnjidic D. The Prevalence of Frailty Among Older Adults Living With Dementia: A Systematic Review. J Am Med Dir Assoc 2022; 23:1807-1814. [DOI: 10.1016/j.jamda.2022.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/11/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
|
13
|
Sönnerstam E, Gustafsson M, Lövheim H. Potentially inappropriate medications in relation to length of nursing home stay among older adults. BMC Geriatr 2022; 22:70. [PMID: 35065614 PMCID: PMC8783464 DOI: 10.1186/s12877-021-02639-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background To investigate the use of potentially inappropriate medications and their relation to the length of nursing home stay among older adults. Methods Questionnaire surveys using the Multi-Dimensional Dementia Assessment scale were sent out to all nursing homes in Västerbotten county in northern Sweden in 2007 and 2013. In total, 3186 adults (1881 from 2007 and 1305 from 2013) ≥65 years old were included and 71.8% of those had cognitive impairment. Potentially inappropriate medications were identified using drug-specific quality indicators according to Swedish National Board of Health and Welfare. Results Potentially inappropriate medications were used by 48.0% of the 2007 study sample and by 28.4% of the 2013 study sample. The prevalence of glibenclamide use 2007 and antipsychotic drug use 2013 increased linearly (β = 0.534E− 3, 95% CI: 0.040E− 3-0.103E− 2, p = 0.034 and β = 0.155E− 2, 95% CI: 0.229E− 3-0.288E− 2, p = 0.022, respectively) with the length of nursing home stay. No significant association was found between the prevalence of propiomazine, codeine, long-acting benzodiazepines, anticholinergics, NSAIDs, tramadol or the total use of potentially inappropriate medications and the length of stay in nursing homes in 2007 or 2013. Antipsychotics were the most commonly prescribed of the drug classes investigated and used by 22.6% of the residents 2007 and by 16.0% of the residents 2013. Conclusions These results indicate that treatment with potentially inappropriate medications is common among older adults living in nursing homes, but it seems to be related to the length of nursing home stay only to a smaller extent. Drug treatment should regularly be reviewed and followed-up among nursing home residents regardless of their length of nursing home stay, in order to prevent unnecessary adverse events. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02639-3.
Collapse
|
14
|
Tjia J, Lund JL, Mack DS, Mbrah A, Yuan Y, Chen Q, Osundolire S, McDermott CL. Methodological Challenges for Epidemiologic Studies of Deprescribing at the End of Life. CURR EPIDEMIOL REP 2021; 8:116-129. [PMID: 34722115 PMCID: PMC8553236 DOI: 10.1007/s40471-021-00264-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Purpose of Review To describe approaches to measuring deprescribing and associated outcomes in studies of patients approaching end of life (EOL). Recent Findings We reviewed studies published through 2020 that evaluated deprescribing in patients with limited life expectancy and approaching EOL. Deprescribing includes reducing the number of medications, decreasing medication dose(s), and eliminating potentially inappropriate medications. Tools such as STOPPFrail, OncPal, and the Unnecessary Drug Use Measure can facilitate deprescribing. Outcome measures vary and selection of measures should align with the operationalized deprescribing definition used by study investigators. Summary EOL deprescribing considerations include medication appropriateness in the context of patient goals for care, expected benefit from medication given life expectancy, and heightened potential for medication-related harm as death nears. Additional data are needed on how EOL deprescribing impacts patient quality of life, caregiver burden, and out-of-pocket medication-related costs to patients and caregivers. Investigators should design deprescribing studies with this information in mind.
Collapse
Affiliation(s)
- Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Jennifer L Lund
- Department of Epidemiology, UNC Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Deborah S Mack
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Attah Mbrah
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Yiyang Yuan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Qiaoxi Chen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Seun Osundolire
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA 01605, USA
| | - Cara L McDermott
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
15
|
Liau SJ, Bell JS. Frailty Status and Cognitive Function Should Guide Prescribing in Long-term Care Facilities. Sr Care Pharm 2021; 36:469-473. [PMID: 34593087 DOI: 10.4140/tcp.n.2021.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Frailty, dementia and complex multimorbidity are highly prevalent among residents of long-term care facilities (LTCFs). Prescribing for residents of LTCFs is often informed by disease-specific clinical practice guidelines based on research conducted among younger and more robust adults. However, frailty and cognitive impairment may modify medication benefits and risks. Residents with frailty and advanced dementia may be at increased susceptibility to adverse drug events (ADEs) and often have a lower likelihood of achieving long-term therapeutic benefit from chronic preventative medications. For this reason, there is a strong rationale for deprescribing, particularlyamong residents with high medication burdens, swallowing difficulties or limited dexterity. Conversely, frailty and dementia have also been associated with under-prescribing of clinically indicated medications. Unnecessarily withholding treatment based on assumed risk may deprive vulnerable population groups from receiving evidence-based care. There is a need for specific evidence regarding medication benefits and risks in LTCF residents with frailty and dementia. Observational studies conducted using routinely collected health data may complement evidence from randomized controlled trials that often exclude people living with dementia, frailty and in LTCFs. Balancing over- and under-prescribing requires consideration of each resident's frailty and cognitive status, therapeutic goals, time-to-benefit, potential ADEs, and individual values or preferences. Incorporating frailty screening into medication review may also provide better alignment of medication regimens to changing goals of care. Timely identification of frail residents as part of treatment decision-making may assist with targeting interventions to minimize and monitor for ADEs. Shifting away from rigid application of conventional disease-specific clinical practice guidelines may provide an individualized and more holistic assessment of medication benefits and risks in the LTCF setting.
Collapse
Affiliation(s)
- Shin J Liau
- Research Pharmacist, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia, National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia
| | - J Simon Bell
- Professor and Director, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia, National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia
| |
Collapse
|
16
|
Sluggett JK, Hughes GA, Ooi CE, Chen EYH, Corlis M, Hogan ME, Caporale T, Van Emden J, Bell JS. Process Evaluation of the SImplification of Medications Prescribed to Long-tErm Care Residents (SIMPLER) Cluster Randomized Controlled Trial: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115778. [PMID: 34072223 PMCID: PMC8199013 DOI: 10.3390/ijerph18115778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 02/01/2023]
Abstract
Complex medication regimens are highly prevalent, burdensome for residents and staff, and associated with poor health outcomes in residential aged care facilities (RACFs). The SIMPLER study was a non-blinded, matched-pair, cluster randomized controlled trial in eight Australian RACFs that investigated the one-off application of a structured 5-step implicit process to simplify medication regimens. The aim of this study was to explore the processes underpinning study implementation and uptake of the medication simplification intervention. A mixed methods process evaluation with an explanatory design was undertaken in parallel with the main outcome evaluation of the SIMPLER study and was guided by an established 8-domain framework. The qualitative component included a document analysis and semi-structured interviews with 25 stakeholders (residents, family, research nurses, pharmacists, RACF staff, and a general medical practitioner). Interviews were transcribed verbatim and reflexively thematically content analyzed. Descriptive statistics were used to summarize quantitative data extracted from key research documents. The SIMPLER recruitment rates at the eight RACFs ranged from 18.9% to 48.6% of eligible residents (38.4% overall). Participation decisions were influenced by altruism, opinions of trusted persons, willingness to change a medication regimen, and third-party hesitation regarding potential resident distress. Intervention delivery was generally consistent with the study protocol. Stakeholders perceived regimen simplification was beneficial and low risk if the simplification recommendations were individualized. Implementation of the simplification recommendations varied between the four intervention RACFs, with simplification implemented at 4-month follow-up for between 25% and 86% of residents for whom simplification was possible. Good working relationships between stakeholders and new remunerated models of medication management were perceived facilitators to wider implementation. In conclusion, the one-off implicit medication simplification intervention was feasible and generally delivered according to the protocol to a representative sample of residents. Despite variable implementation, recommendations to simplify complex regimens were valued by stakeholders, who also supported wider implementation of medication simplification in RACFs.
Collapse
Affiliation(s)
- Janet K. Sluggett
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
- Correspondence:
| | - Georgina A. Hughes
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia;
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
| | - Esa Y. H. Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
| | - Megan Corlis
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
| | - Michelle E. Hogan
- Helping Hand Aged Care, North Adelaide, SA 5006, Australia; (M.E.H.); (T.C.)
| | - Tessa Caporale
- Helping Hand Aged Care, North Adelaide, SA 5006, Australia; (M.E.H.); (T.C.)
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia;
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| |
Collapse
|
17
|
Dugré N, Bell JS, Hopkins RE, Ilomäki J, Chen EYH, Corlis M, Van Emden J, Hogan M, Sluggett JK. Impact of Medication Regimen Simplification on Medication Incidents in Residential Aged Care: SIMPLER Randomized Controlled Trial. J Clin Med 2021; 10:jcm10051104. [PMID: 33800845 PMCID: PMC7961370 DOI: 10.3390/jcm10051104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 01/03/2023] Open
Abstract
In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we investigated the impact of a structured medication regimen simplification intervention on medication incidents in residential aged care facilities (RACFs) over a 12-month follow-up. A clinical pharmacist applied the validated 5-step Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) for 96 of the 99 participating residents in the four intervention RACFs. The 143 participating residents in the comparison RACFs received usual care. Over 12 months, medication incident rates were 95 and 66 per 100 resident-years in the intervention and comparison groups, respectively (adjusted incident rate ratio (IRR) 1.13; 95% confidence interval (CI) 0.53-2.38). The 12-month pre/post incident rate almost halved among participants in the intervention group (adjusted IRR 0.56; 95%CI 0.38-0.80). A significant reduction in 12-month pre/post incident rate was also observed in the comparison group (adjusted IRR 0.67, 95%CI 0.50-0.90). Medication incidents over 12 months were often minor in severity. Declines in 12-month pre/post incident rates were observed in both study arms; however, rates were not significantly different among residents who received and did not receive a one-off structured medication regimen simplification intervention.
Collapse
Affiliation(s)
- Nicolas Dugré
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- Faculty of Pharmacy, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Clinique Universitaire de Médecine Familiale Sacré-Coeur, Montréal, QC H3M 3A9, Canada
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
- Correspondence: ; Tel.: +61-3-9903-9533
| | - Ria E. Hopkins
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Esa Y. H. Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia
| | - Michelle Hogan
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia
| | - Janet K. Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- UniSA Allied Health and Human Performance Unit, City East campus, University of South Australia, Adelaide, SA 5001, Australia
| |
Collapse
|
18
|
Liau SJ, Lalic S, Visvanathan R, Dowd LA, Bell JS. The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes. J Nutr Health Aging 2021; 25:1205-1216. [PMID: 34866147 PMCID: PMC8549594 DOI: 10.1007/s12603-021-1694-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022]
Abstract
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 cut-offs, 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.
Collapse
Affiliation(s)
- S J Liau
- Shin J. Liau, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 407 Royal Parade, Parkville, Victoria 3052, Australia. E-mail:
| | | | | | | | | |
Collapse
|
19
|
Sharma M, Wong XY, Bell JS, Corlis M, Hogan M, Sluggett JK. Trajectories of pro re nata (PRN) medication prescribing and administration in long-term care facilities. Res Social Adm Pharm 2020; 17:1463-1468. [PMID: 33223395 DOI: 10.1016/j.sapharm.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about changes in pro re nata (PRN) medication prescribing and administration in residential aged care facilities (RACFs) over time. OBJECTIVE To determine the prevalence and factors associated with PRN medication administration in RACFs and examine changes over 12-months. METHODS Secondary analyses utilizing data from the SIMPLER randomized controlled trial (n = 242 residents, 8 RACFs) was undertaken. PRN medication data were extracted from RACF medication charts. Factors associated with PRN medication administration in the preceding week were explored using multivariable logistic regression. RESULTS At baseline, 211 residents (87.2%) were prescribed ≥1 PRN medication, with 77 (36.5%) administered PRN medication in the preceding week. PRN administration was more likely in non-metropolitan areas, and less likely among residents with more severe dementia symptoms and greater dependence with activities of daily living. No significant differences in overall PRN prescribing or administration in 162 residents alive at 12-month follow-up were observed. CONCLUSIONS Despite being frequently prescribed, the contribution of PRNs to overall medication use in RACFs is small. PRN prescribing and administration was relatively static over 12-months despite likely changes in resident health status over this period, suggesting further exploration of PRN prescribing in relation to resident care needs may be warranted.
Collapse
Affiliation(s)
- Monica Sharma
- University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Xin Yee Wong
- University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Megan Corlis
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Michelle Hogan
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians (ROSA), Health Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
| |
Collapse
|
20
|
Sluggett JK, Ooi CE, Gibson S, Angley MT, Corlis M, Hogan ME, Caporale T, Hughes GA, Van Emden J, Bell JS. Simplifying Medication Regimens for People Receiving Community-Based Home Care Services: Outcomes of a Non-Randomized Pilot and Feasibility Study. Clin Interv Aging 2020; 15:797-809. [PMID: 32581521 PMCID: PMC7276197 DOI: 10.2147/cia.s248377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/01/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose Being able to manage a complex medication regimen is key to older people continuing to live at home. This study determined the feasibility of a multi-component intervention to simplify medication regimens for people receiving community-based home care services. Patients and Methods Research nurses recruited people receiving community-based home care services to participate in this non-randomized pilot and feasibility study (Australian New Zealand Clinical Trials Registry ACTRN12618001130257). Participants received a one-off clinical pharmacist intervention comprising medication reconciliation, assessment of capacity to self-manage medications, and application of a structured 5-step tool to identify medication simplification opportunities. A mixed-methods feasibility assessment with an explanatory design was undertaken to assess recruitment, protocol adherence and stakeholder acceptability. Data from interviews with 12 stakeholders were thematically analyzed. Secondary outcome measures, including medication discrepancies, and changes in number of medication administration times per day, quality of life, medication adherence and health service utilization, were determined over a 4-month follow-up. Results Twenty-five out of the target 50 participants were recruited. Initial recruitment was impacted by apparent uncertain role responsibilities in medication management, with some clients who declined to participate perceiving they would be unlikely to benefit or being reluctant to change regimens. However, with few exceptions, participants who received intervention did so with a high degree of protocol adherence and acceptability. Stakeholders valued the intervention and supported wider implementation. Discrepancies between the baseline medication history from the general medical practitioner and the pharmacist-compiled “best possible medication history” were identified for all participants’ regimens (median of 6 per participant), with one-third resolved at follow-up. Simplification was possible for 14 participants (56%) and implemented for 7 (50%) at follow-up. No significant changes in other secondary outcomes were observed. Conclusion The intervention was delivered as planned, and valued by stakeholders. Recruitment barriers should be addressed before wider implementation.
Collapse
Affiliation(s)
- Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia.,National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Stephanie Gibson
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Manya T Angley
- University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Megan Corlis
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Michelle E Hogan
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Tessa Caporale
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Georgina A Hughes
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Jan Van Emden
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
21
|
Teixeira-Gomes A, Lage B, Esteves F, Sousa AC, Pastorinho MR, Valdiglesias V, Costa S, Laffon B, Teixeira JP. Frailty syndrome, biomarkers and environmental factors - A pilot study. Toxicol Lett 2020; 330:14-22. [PMID: 32380123 DOI: 10.1016/j.toxlet.2020.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/31/2020] [Accepted: 04/29/2020] [Indexed: 12/30/2022]
Abstract
Frailty is an age-related syndrome expected to increase over the next decades. This syndrome has been identified to be the most common condition leading to disability, institutionalisation and death in the elderly. The aim of this pilot study is to investigate a possible link between frailty status, biomarkers and environmental exposures. A group of 71 older adults (≥65 years old) was engaged in this study. The study population was classified as 45.1% robust, 45.1% pre-frail and 9.8% frail. A significant higher prevalence of second-hand smokers was found in the pre-frail group when compared to robust. Furthermore, a higher prevalence of robust individuals was found among those consuming home-produced vegetables and water from well/springs. Significant differences were found between data collected in a lifetime exposure questionnaire (LTEQ) and the levels of genotoxicity endpoints and the mercury levels analysed regarding some exposure-related parameters, namely, smoking habits, intake of home-produced vegetables and the use of pesticides in agriculture. Understanding if the way we live(d) or worked can impact the way we age are important questions to be explored. Data obtained in this pilot study encourage further studies on this matter, exploring the role of exposures history and its impact on health.
Collapse
Affiliation(s)
- Armanda Teixeira-Gomes
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal; ICBAS - Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Bruna Lage
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal
| | - Filipa Esteves
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal
| | - Ana Catarina Sousa
- CICS-UBI, University of Beira Interior, Covilhã, Portugal; NuESA, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; CICECO, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - M Ramiro Pastorinho
- CICS-UBI, University of Beira Interior, Covilhã, Portugal; NuESA, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Vanessa Valdiglesias
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; DICOMOSA Group, Area of Psychobiology, Department of Psychology, University of A Coruña, A Coruña, Spain
| | - Solange Costa
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal.
| | - Blanca Laffon
- DICOMOSA Group, Area of Psychobiology, Department of Psychology, University of A Coruña, A Coruña, Spain
| | - João Paulo Teixeira
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal; Environmental Health Department, National Institute of Health, Porto, Portugal
| |
Collapse
|
22
|
Sluggett JK, Hopkins RE, Chen EYH, Ilomäki J, Corlis M, Van Emden J, Hogan M, Caporale T, Ooi CE, Hilmer SN, Bell JS. 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. J Clin Med 2020; 9:E1053. [PMID: 32276360 PMCID: PMC7231224 DOI: 10.3390/jcm9041053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/02/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Janet K. Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA 5005, Australia
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
| | - Ria E. Hopkins
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
| | - Esa YH Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia;
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia;
| | - Michelle Hogan
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia;
| | | | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
| | - Sarah N. Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, School of Medicine, University of Sydney, Sydney, NSW 2050, Australia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (J.K.S.); (R.E.H.); (E.Y.C.); (J.I.); (C.E.O.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.); (S.N.H.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| |
Collapse
|
23
|
Sluggett JK, Chen EYH, Ilomäki J, Corlis M, Van Emden J, Hogan M, Caporale T, Keen C, Hopkins R, Ooi CE, Hilmer SN, Hughes GA, Luu A, Nguyen KH, Comans T, Edwards S, Quirke L, Patching A, Bell JS. Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial. J Am Med Dir Assoc 2020; 21:1114-1120.e4. [PMID: 32179001 DOI: 10.1016/j.jamda.2020.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the application of a structured process to consolidate the number of medication administration times for residents of aged care facilities. DESIGN A nonblinded, matched-pair, cluster randomized controlled trial. SETTING AND PARTICIPANTS Permanent residents who were English-speaking and taking at least 1 regular medication, recruited from 8 South Australian residential aged care facilities (RACFs). METHODS The intervention involved a clinical pharmacist applying a validated 5-step tool to identify opportunities to reduce medication complexity (eg, by administering medications at the same time or through use of longer-acting or combination formulations). Residents in the comparison group received routine care. The primary outcome at 4-month follow-up was the number of administration times per day for medications charted regularly. Resident satisfaction and quality of life were secondary outcomes. Harms included falls, medication incidents, hospitalizations, and mortality. The association between the intervention and primary outcome was estimated using linear mixed models. RESULTS Overall, 99 residents participated in the intervention arm and 143 in the comparison arm. At baseline, the mean resident age was 86 years, 74% were female, and medications were taken an average of 4 times daily. Medication simplification was possible for 62 (65%) residents in the intervention arm, with 57 (62%) of 92 simplification recommendations implemented at follow-up. The mean number of administration times at follow-up was reduced in the intervention arm in comparison to usual care (-0.36, 95% confidence interval -0.63 to -0.09, P = .01). No significant changes in secondary outcomes or harms were observed. CONCLUSIONS AND IMPLICATIONS One-off application of a structured tool to reduce regimen complexity is a low-risk intervention to reduce the burden of medication administration in RACFs and may enable staff to shift time to other resident care activities.
Collapse
Affiliation(s)
- Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
| | - Esa Y H Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Michelle Hogan
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Tessa Caporale
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Claire Keen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Ria Hopkins
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Georgina A Hughes
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Andrew Luu
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Kim-Huong Nguyen
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Centre for Health Services Research, The University of Queensland, Woolloogabba, Queensland, Australia
| | - Tracy Comans
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Centre for Health Services Research, The University of Queensland, Woolloogabba, Queensland, Australia
| | - Susan Edwards
- Drug & Therapeutics Information Service, GP Plus Marion, South Australia, Australia
| | - Lyntara Quirke
- Consumer Representative, Dementia Australia, Scullin, Australian Capital Territory, Australia
| | - Allan Patching
- Helping Hand Consumer and Carer Reference Group, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|