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Kirsch C, Doyle IM, Krause O, Junius-Walker U, Wiese B, Thürmann P, Sparenberg LC, Wollny A, Fuchs A, Wilm S, Joos S, Stolz R, Haumann H. „Lessons learned“ – Herausforderungen im Rekrutierungsprozess in der cluster-randomisierten Pflegeheimstudie „HIOPP-3 iTBX“. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 156-157:24-32. [DOI: 10.1016/j.zefq.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 02/01/2023]
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Medikamentennachweise bei bayerischen Altenheimbewohnern – eine rechtsmedizinische Analyse. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Krause O, Wiese B, Doyle IM, Kirsch C, Thürmann P, Wilm S, Sparenberg L, Stolz R, Freytag A, Bleidorn J, Junius-Walker U. Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study). BMC Geriatr 2019; 19:24. [PMID: 30683060 PMCID: PMC6347799 DOI: 10.1186/s12877-019-1027-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/04/2019] [Indexed: 01/29/2023] Open
Abstract
Background Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR’ health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists’ medication reviews linked with measures to strengthen interprofessional co-operation on NHR’ medication quality, health status and health care use. Methods Pragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist’s medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a “toolbox” to facilitate implementation in daily practice. Analysis: primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs. Discussion The trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany. Trial registration Registered in the German register of clinical studies (DRKS, study ID DRKS00013588, primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.
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Affiliation(s)
- Olaf Krause
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Birgitt Wiese
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Ina-Merle Doyle
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Claudia Kirsch
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Petra Thürmann
- Philipp Klee Institute for Clinical Pharmacology, University of Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Stefan Wilm
- Institute for General Practice, Heinrich-Heine University Düsseldorf, Werdener Straße 4, 40227, Düsseldorf, Germany
| | - Lisa Sparenberg
- Institute for General Practice, University Medical Center Rostock, Doberaner Straße 142, 18057, Rostock, Germany
| | - Regina Stolz
- Institute for General Practice and Interprofessional Care, University Hospital and Faculty Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Jutta Bleidorn
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Ulrike Junius-Walker
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Gertz HJ, Stoppe G, Müller-Oerlinghausen B, Schmidt L, Baethge C, Hiemke C, Lieb K, Bschor T. Antipsychotika zur Behandlung neuropsychiatrischer Störungen bei Demenz. DER NERVENARZT 2012; 84:370-3. [DOI: 10.1007/s00115-012-3693-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Psychotropic medication use among nursing home residents in Austria: a cross-sectional study. BMC Geriatr 2009; 9:18. [PMID: 19460135 PMCID: PMC2697155 DOI: 10.1186/1471-2318-9-18] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/21/2009] [Indexed: 12/14/2022] Open
Abstract
Background The use of psychotropic medications and their adverse effects in frail elderly has been debated extensively. However, recent data from European studies show that these drugs are still frequently prescribed in nursing home residents. In Austria, prevalence data are lacking. We aimed to determine the prevalence of psychotropic medication prescription in Austrian nursing homes and to explore characteristics associated with their prescription. Methods Cross-sectional study and association analysis in forty-eight out of 50 nursing homes with 1844 out of a total of 2005 residents in a defined urban-rural region in Austria. Prescribed medication was retrieved from residents' charts. Psychotropic medications were coded according to the Anatomical Therapeutic Chemical Classification 2005. Cluster-adjusted multiple logistic regression analysis was performed to investigate institutional and residents' characteristics associated with prescription. Results Residents' mean age was 81; 73% of residents were female. Mean cluster-adjusted prevalence of residents with at least one psychotropic medication was 74.6% (95% confidence interval, CI, 72.0–77.2). A total of 45.9% (95% CI 42.7–49.1) had at least one prescription of an antipsychotic medication. Two third of all antipsychotic medications were prescribed for bedtime use only. Anxiolytics were prescribed in 22.2% (95% CI 20.0–24.5), hypnotics in 13.3% (95% CI 11.3–15.4), and antidepressants in 36.8% (95% CI 34.1–39.6) of residents. None of the institutional characteristics and only few residents' characteristics were significantly associated with psychotropic medication prescription. Permanent restlessness was positively associated with psychotropic medication prescription (AOR 1.54, 95% CI 1.32–1.79) whereas cognitive impairment was inversely associated (AOR 0.70, 95% CI 0.56–0.88). Conclusion Frequency of psychotropic medication prescription is high in Austrian nursing homes compared to recent published data from other countries. Interventions should aim at reduction and optimisation of prescriptions.
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Cohen-Mansfield J, Lipson S, Patel D, Tomsko-Nay P, Alvarez C, Wilks G, Compton G, Doyle D, Smith M. Wisdom From the Front Lines: Clinicians’ Descriptions of Treating Agitation in the Nursing Home, A Pilot Study. J Am Med Dir Assoc 2005; 6:257-64. [PMID: 16005412 DOI: 10.1016/j.jamda.2005.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The management of behavior problems is one of the most difficult challenges a clinician must face when treating patients with dementia. This article presents a qualitative analysis of the responses of 7 nursing home physicians and 1 nurse practitioner to open-ended questions regarding their experiences in treating behavior problems in dementia with an emphasis on nonpharmalogical methods. This study serves to highlight both the issues encountered by those commonly asked to treat behavior problems in the nursing home, and the thoughtfulness and insight developed by some clinicians to address the problems. Several themes emerged from clinicians' responses. Some of the clinicians developed algorithms for treating behavior problems. Some of the clinicians were frustrated with the expectation that behavior problems would be effectively treated pharmacologically. The treatment of behavior problems was described as complex and requiring more time than is allocated by reimbursement systems. They also expressed the need for multiple systemic changes in order to improve treatment, and provided many examples of inadequate resources, including reimbursement, staff, activities, staff training, and management issues needed to improve treatment of behavior problems in nursing home residents. On the positive side, they reported a high level of satisfaction when treating behavior nonpharmacologically. The clinicians felt that with appropriate systemic change many behavior problems can be either prevented or treated effectively by nonpharmacological means.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Research Institute on Aging of the Hebrew Home of Greater Washington, George Washington University Medical Center, Rockville, MD 20852, USA.
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Pittrow D, Krappweis J, Rentsch A, Schindler C, Hach I, Bramlage P, Kirch W. Pattern of prescriptions issued by nursing home-based physicians versus office-based physicians for frail elderly patients in German nursing homes. Pharmacoepidemiol Drug Saf 2003; 12:595-9. [PMID: 14558183 DOI: 10.1002/pds.860] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study was to describe the physician prescription pattern for frail elderly patients in German nursing homes and to identify differences, if any, between that of physicians based in the nursing homes (A) and those with office-based practices (B). METHODS Retrospective, longitudinal study of medication prescriptions on the basis of the database of a health insurance (Betriebskrankenkasse) in Berlin, Germany. We assessed the medication prescriptions for all 996 unselected insured individuals aged > or = 60 years who were insured throughout 1999 and lived in nursing homes. We analyzed selected patient characteristics and prescription data. Drugs were classified according to the WHO ATC code and were assigned a mean daily defined dose (DDD). RESULTS 816 individuals were women and 180 were men. A total of 78% of women and 43% of men were aged 80 years or older. Two hundred sixty three patients were seen by nursing home-based physicians (A) and 733 by office-based physicians (B). The median of prescriptions per patient and year was 31 (A) and 37 (B) (p between groups < 0.001). Patients in Group A also received a lower number of DDDs in comparison to Group B (1109 vs 1250; p < 0.01). Costs were substantially higher in group B, and in both groups higher in the 60-69 years old in comparison to the more senior patients. The prescription pattern suggested a considerable frequency of inappropriate drug use in both groups in the following classes: psychopharmacological agents (neuroleptics, antidepressants, hypnotics), pain medication, digitalis glycosides, laxants and loop diuretics. On an average, office-based physicians (B) prescribed relatively more medications in all major classes with the exception of non-opiate analgesics, laxants and anxiolytics. CONCLUSIONS These data are indicative of a considerable use of inappropriate medication for frail geriatric patients. Differences between the prescribing pattern among nursing home-based and office-based physicians were not substantial, however, the latter group prescribed relatively more drugs.
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Affiliation(s)
- David Pittrow
- Institute of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Fiedlerstr 27, D-01307 Dresden, Germany.
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