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Sluggett JK, Stasinopoulos J, Sylvester C, Wong WJ, Hillen J, Hughes GA, Yu S, Clark M, Bell JS, Corlis M, Teng LS, Newton L, Piovezan RD, Yu D, Carter L, Soulsby N. Simplifying medication regimens for residents of aged care facilities: Pharmacist and physician use of a structured five-step medication simplification tool. Res Social Adm Pharm 2024:S1551-7411(24)00122-0. [PMID: 38693035 DOI: 10.1016/j.sapharm.2024.04.008] [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: 09/12/2023] [Revised: 03/08/2024] [Accepted: 04/07/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Pharmacist-led medication regimen simplification using a structured approach can reduce unnecessary medication regimen complexity in residential aged care facilities (RACFs), but no studies have investigated simplification by different health professionals, nor the extent to which simplification is recommended during comprehensive medication reviews. OBJECTIVES To compare medication regimen simplification opportunities identified by pharmacists, general medical practitioners (GPs), and geriatricians and to determine if pharmacists identified simplification opportunities during routinely conducted comprehensive medication reviews in RACFs for these same residents. METHODS Three pharmacists, three GPs and three geriatricians independently applied the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) to medication data for 83 residents taking medications at least twice daily. Interrater agreement was calculated using Fleiss's kappa. Pharmacist medication review reports for the same 83 residents were then examined to identify if the pharmacists conducting these reviews had recommended any of the simplification strategies. RESULTS Overall, 77 residents (92.8 %) taking medications at least twice daily could have their medication regimen simplified by at least one health professional. Pharmacists independently simplified 53.0-77.1 % of medication regimens (Κ = 0.60, 95%CI 0.46-0.75, indicating substantial agreement), while GPs simplified 74.7-89.2 % (Κ = 0.44, 95%CI 0.24-0.64, moderate agreement) and geriatricians simplified 41.0-66.3 % (Κ = 0.30, 95%CI 0.16-0.44, fair agreement). No simplification recommendations were included in the reports previously prepared by pharmacists as part of the comprehensive medication reviews undertaken for these residents. CONCLUSION Pharmacists, GPs, and geriatricians can all identify medication regimen simplification opportunities, although these opportunities differ within and between professional groups. Although opportunities to simplify medication regimens during comprehensive medication reviews exist, simplification is not currently routinely recommended by pharmacists performing these reviews in Australian RACFs.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
| | - Jacquelina Stasinopoulos
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Cyan Sylvester
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Wei Jin Wong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya, Selangor, Malaysia
| | - Jodie Hillen
- Ward Medication Management, Melbourne, Victoria, Australia; University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Georgina A Hughes
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Solomon Yu
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Malcolm Clark
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia; IPN Medical Centres, Camberwell, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation (SA Branch), Adelaide, South Australia, Australia
| | - Loui Sa Teng
- General Practitioner, Narre Warren, Victoria, Australia
| | - Lisa Newton
- IPN Medical Centres, Camberwell, Victoria, Australia
| | - Ronaldo D Piovezan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - David Yu
- The Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Lynda Carter
- Ward Medication Management, Melbourne, Victoria, Australia
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Lim R, Bilton R, Dorj G, Bereznicki L, Rowett D, Ho JN, Freeman A, Roughead EE. Pharmacists as patient advocates: A series of case studies illustrating the impacts of a regular pharmacist service in residential aged care (nursing homes). EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 10:100268. [PMID: 37151371 PMCID: PMC10160770 DOI: 10.1016/j.rcsop.2023.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023] Open
Abstract
Background Medicine-related problems are common in older people living in residential aged care facilities (RACFs). Recognising the significant medicine-related problems, the Australian government has announced a $345 million funding package to employ on-site pharmacists in RACFs starting in 2023. The new on-site pharmacists are to provide a range of clinical services to reduce medicine-related adverse events, promote quality use of medicines, and improve clinical governance and education. Underpinning these services, the authors argue that pharmacists play the critical role as resident advocates. Objective This study aims to demonstrate how pharmacists can enhance their advocacy responsibility within and beyond the clinical environment to not only reduce medicine-related adverse events but also improve residents' overall health and quality of life. Methods This study uses a case series methodology to demonstrate pharmacists' diverse roles in advocating for residents and their families. The case studies were based on participants enrolled in the Reducing Medicine-Induced Deterioration and Adverse Reactions (ReMInDAR) trial, a randomised controlled trial testing the effects of a regular pharmacist service across the Australian RACFs. Results Pharmacists' advocacy ranged from persistence in follow-up with a resident's general practitioner (GP) to ensure the GP was aware that a patient was experiencing bleeding and bruising while on an anticoagulant, to advocating for a new bed for a resident with peripheral oedema who had been sleeping in his chair due to fear of falling out of his current bed. Conclusions Our trial focussed on pharmacists serving as the residents' advocate to improve their overall health and quality of life, rather than just addressing a list of medicine-related problems. The pharmacist model used in the ReMInDAR trial supports pharmacists to work to their full scope of practice, helps guide the Australian government's new on-site pharmacist program, and serves as an exemplar pharmacist in aged care model internationally.
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Affiliation(s)
- Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
- Corresponding author.
| | - Rebecca Bilton
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
| | - Gereltuya Dorj
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
| | - Luke Bereznicki
- School of Medicine, University of Tasmania, Hobart 7000, Australia
| | - Debra Rowett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
| | - Jun Ni Ho
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
| | - Anthea Freeman
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide 5000, Australia
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Poupin P, Ansoborlo M, Caille A, Dibao-Dina C, Fougère B, Giraudeau B. Management of death-related noncompleters in cluster randomized trials carried out in nursing homes: a methodological review. J Clin Epidemiol 2022; 151:132-142. [PMID: 35963566 DOI: 10.1016/j.jclinepi.2022.08.001] [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: 01/07/2022] [Revised: 04/22/2022] [Accepted: 08/04/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND A noncompleter is defined as a participant who leaves a trial before the end of the planned follow-up. Research in nursing homes is highly exposed to this problem because of high death rates. OBJECTIVES The aim of this trial is to assess the statistical management of noncompleters in cluster randomized trials carried out in nursing homes. STUDY DESIGN AND SETTING A methodological review of published cluster randomized trials. RESULTS We selected 37 articles. For 22 (59%) trials, the design was closed-cohort (i.e., participants included all at the same time when randomizing clusters). In those 22 closed-cohort trials, the median follow-up was 6.5 months (interquartile range 4-12). The median noncompleter rate was 19.5% and the median noncompletions due to death was 73.2%. In only one trial were the baseline characteristics of completers and noncompleters compared. Strategies to deal with noncompleters were an inflation of the planned sample size (11 trials), the use of repeated measurements of the outcome (12 trials), and the use of imputation methods when analyzing data (7 trials). CONCLUSION In cluster randomized trials of nursing homes, noncompleters are managed as for any missing data, but they are essentially due to death. Methodological and statistical developments and guidance are needed.
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Affiliation(s)
- Pierre Poupin
- Division of Geriatric Medicine, Tours University Hospital, Tours, France; INSERM CIC 1415, Tours University Hospital, Tours, France.
| | | | - Agnès Caille
- INSERM CIC 1415, Tours University Hospital, Tours, France; Tours University, Nantes University, INSERM, SPHERE U1246, Tours, France
| | | | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France; Education, Ethics, Health (EA 7505), Tours University, Tours, France
| | - Bruno Giraudeau
- INSERM CIC 1415, Tours University Hospital, Tours, France; Tours University, Nantes University, INSERM, SPHERE U1246, Tours, France
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Interprofessional Interventions Involving Pharmacists and Targeting the Medicines Management Process Provided to Older People Residing in Nursing Homes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Drugs Aging 2022; 39:773-794. [PMID: 36194370 DOI: 10.1007/s40266-022-00978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nursing home residents are often prescribed multiple medications, which increases their susceptibility to drug-related problems. The medicines management process involves multiple stages, for example, assessing, prescribing, dispensing, delivering and storing, administering, reviewing and monitoring. The medicine management process aims to optimise medicine use and associated patient outcomes. Interprofessional interventions of healthcare professionals from different disciplines in many clinical settings, including the nursing home setting, have shown success in improving patients' clinical outcomes. However, reporting of the pharmacist's role and the impact of these interventions has been unclear. OBJECTIVES We aimed to systematically identify and describe interprofessional interventions involving pharmacists that target the medicine management process in nursing homes by (a) describing interprofessional interventions and the role of pharmacists within, (b) describing the impact of these interventions, (c) exploring which of the medicine management process stages were targeted and (d) identifying any reported theoretical underpinning. METHODS EMBASE, MEDLINE, CINAHL, SCOPUS, PsycInfo, Cochrane library, Web of Science and clinical trial registers were searched from the inception date until August 2021. Randomised controlled trials reporting interprofessional interventions involving pharmacists, targeting at least one stage of the medicine management process and provided to nursing home residents with a mean age ≥ 65 years, were included. The search had no restriction on outcomes measured. Included randomised controlled trials were assessed for quality and risk of bias using the Jadad scale and Cochrane Collaboration tool, respectively. The overall certainty of outcomes was assessed using GRADEpro. If present, details about theoretical underpinning were extracted using the theory coding scheme. Fixed and random-effects models were used to calculate the pooled effect estimates to compare outcomes between intervention and control groups, where feasible, or a narrative description was reported. RESULTS Eighteen manuscripts describing interprofessional interventions involving pharmacists were identified: medication review (n = 14), education (n = 3) and medication simplification (n = 1) based interventions. The pharmacists' most frequent role was the provision of medicine-related recommendations, and they worked mostly with general practitioners and nurses. Residents/family members contributed in 44% of included interventions. A meta-analysis identified that interventions were significantly associated with significant improvements in prescribing appropriateness (standard mean difference - 0.20; 95% confidence interval - 0.33 to - 0.77; I2 = 27%) but not with hospitalisation and mortality. None of the included studies reported a theoretical underpinning to intervention development. CONCLUSIONS This systematic review provides a detailed description of the impact of interprofessional practice, involving pharmacists, which targets at least one stage of the medicine management process in the nursing home setting. The findings suggest that future research should prioritise improving prescribing inappropriateness rather than the number of long-term medications prescribed. It remains unknown if interventions are designed using theory and, therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. CLINICAL TRIAL REGISTRATION The protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO) [Ref: CRD42020181744].
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Sluggett JK, Rigby D. Simplifying medications for people with type 2 diabetes. BMJ 2022; 376:n3158. [PMID: 34987063 DOI: 10.1136/bmj.n3158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Janet K Sluggett
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Debbie Rigby
- School of Pharmacy, University of Queensland, Woolloongabba, QLD, Australia
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Hamel C, Garritty C, Hersi M, Butler C, Esmaeilisaraji L, Rice D, Straus S, Skidmore B, Hutton B. Models of provider care in long-term care: A rapid scoping review. PLoS One 2021; 16:e0254527. [PMID: 34270578 PMCID: PMC8284811 DOI: 10.1371/journal.pone.0254527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION One of the current challenges in long-term care homes (LTCH) is to identify the optimal model of care, which may include specialty physicians, nursing staff, person support workers, among others. There is currently no consensus on the complement or scope of care delivered by these providers, nor is there a repository of studies that evaluate the various models of care. We conducted a rapid scoping review to identify and map what care provider models and interventions in LTCH have been evaluated to improve quality of life, quality of care, and health outcomes of residents. METHODS We conducted this review over 10-weeks of English language, peer-reviewed studies published from 2010 onward. Search strategies for databases (e.g., MEDLINE) were run on July 9, 2020. Studies that evaluated models of provider care (e.g., direct patient care), or interventions delivered to facility, staff, and residents of LTCH were included. Study selection was performed independently, in duplicate. Mapping was performed by two reviewers, and data were extracted by one reviewer, with partial verification by a second reviewer. RESULTS A total of 7,574 citations were screened based on the title/abstract, 836 were reviewed at full text, and 366 studies were included. Studies were classified according to two main categories: healthcare service delivery (n = 92) and implementation strategies (n = 274). The condition/ focus of the intervention was used to further classify the interventions into subcategories. The complex nature of the interventions may have led to a study being classified in more than one category/subcategory. CONCLUSION Many healthcare service interventions have been evaluated in the literature in the last decade. Well represented interventions (e.g., dementia care, exercise/mobility, optimal/appropriate medication) may present opportunities for future systematic reviews. Areas with less research (e.g., hearing care, vision care, foot care) have the potential to have an impact on balance, falls, subsequent acute care hospitalization.
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Affiliation(s)
- Candyce Hamel
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chantelle Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mona Hersi
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Claire Butler
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Leila Esmaeilisaraji
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danielle Rice
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto and St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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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.
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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
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Ali S, Salahudeen MS, Bereznicki LRE, Curtain CM. Pharmacist-led interventions to reduce adverse drug events in older people living in residential aged care facilities: A systematic review. Br J Clin Pharmacol 2021; 87:3672-3689. [PMID: 33880786 DOI: 10.1111/bcp.14824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/14/2021] [Accepted: 03/10/2021] [Indexed: 01/12/2023] Open
Abstract
AIMS We aimed to investigate the efficacy and effectiveness of pharmacist-led interventions to reduce adverse drug events (ADEs) in older people living in residential aged care facilities (RACFs). METHODS We systematically searched MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from their inceptions to July 2020. We investigated experimental study designs that employed a control group, or quasi-experimental studies conducted in RACFs. RESULTS We screened 3826 records and included 23 studies. We found seven single-component and 16 multicomponent pharmacist-led interventions to reduce ADEs in older people living in RACFs. The most frequent single-component pharmacist-led intervention was medication review. Medication review and education provision to healthcare professionals were the most common components in many pharmacist-led multicomponent interventions. Thirteen studies (56%) showed no effect, whereas ten studies (43%) reported significant reductions in ADEs following pharmacist-led interventions either as a sole intervention or as a part of a multi-component intervention. Many interventions focused on reducing the incidence of falls (39%). CONCLUSIONS This systematic review suggests that pharmacist-led interventions have the potential to reduce the incidence of ADEs in older people living in RACFs. Medication review and educational programmes, particularly academic detailing, either as a single component or as part of multicomponent interventions were the most common approaches to reducing drug-related harm in older people living in RACFs. The lack of a positive association between interventions and ADE in many studies suggests that targeted and tailored pharmacist-led interventions are required to reduce ADEs in older people in RACFs.
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Affiliation(s)
- Sheraz Ali
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, 7005, Australia
| | - Mohammed S Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, 7005, Australia
| | - Luke R E Bereznicki
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, 7005, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, 7005, Australia
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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.
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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
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10
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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.
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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:
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11
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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.
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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.
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12
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Liau SJ, Lalic S, Sluggett JK, Cesari M, Onder G, Vetrano DL, Morin L, Hartikainen S, Hamina A, Johnell K, Tan ECK, Visvanathan R, Bell JS. Medication Management in Frail Older People: Consensus Principles for Clinical Practice, Research, and Education. J Am Med Dir Assoc 2020; 22:43-49. [PMID: 32669236 DOI: 10.1016/j.jamda.2020.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/25/2020] [Accepted: 05/02/2020] [Indexed: 12/18/2022]
Abstract
Frailty is a geriatric condition associated with increased vulnerability to adverse drug events and medication-related harm. Existing clinical practice guidelines rarely provide medication management recommendations specific to frail older people. This report presents international consensus principles, generated by the Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network, related to medication management in frail older people. This consensus comprises 7 principles for clinical practice, 6 principles for research, and 4 principles for education. Principles for clinical practice include (1) perform medication reconciliation and maintain an up-to-date medication list; (2) assess and plan based on individual's capacity to self-manage medications; (3) ensure appropriate prescribing and deprescribing; (4) simplify medication regimens when appropriate to reduce unnecessary burden; (5) be alert to the contribution of medications to geriatric syndromes; (6) regularly review medication regimens to align with changing goals of care; and (7) facilitate multidisciplinary communication among patients, caregivers, and healthcare teams. Principles for research include (1) include frail older people in randomized controlled trials; (2) consider frailty status as an effect modifier; (3) ensure collection and reporting of outcome measures important in frailty; (4) assess impact of frailty on pharmacokinetics and pharmacodynamics; (5) encourage frailty research in under-researched settings; and (6) utilize routinely collected linked health data. Principles for education include (1) provide undergraduate and postgraduate education on frailty; (2) minimize low-value care related to medication management; (3) improve health and medication literacy; and (4) incorporate evidence in relation to frailty into clinical practice guidelines. These principles for clinical practice, research and education highlight different considerations for optimizing medication management in frail older people. These principles can be used in conjunction with existing best practice guidelines to help achieve optimal health outcomes for this vulnerable population. Implementation of the principles will require multidisciplinary collaboration between healthcare professionals, researchers, educators, organizational leaders, and policymakers.
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Affiliation(s)
- Shin J Liau
- 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, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Pharmacy Department, Monash Health, Melbourne, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Centro Medicina dell'Invecchiamento, IRCCS Fondazione Policlinico Universitario A. Gemelli, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucas Morin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Inserm CIC 1431, University Hospital of Besançon, Besançon, France
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Aleksi Hamina
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Edwin C K Tan
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia; Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - J Simon Bell
- 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, Australia; Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
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13
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Scott IA, Rigby D, Hilmer SN. Optimising medication management during the COVID-19 pandemic. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020; 50:186-189. [PMID: 34173432 PMCID: PMC7361261 DOI: 10.1002/jppr.1668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital Brisbane Australia.,University of Queensland Brisbane Australia
| | - Debbie Rigby
- University of Queensland Brisbane Australia.,Queensland University of Technology Brisbane Australia
| | - Sarah N Hilmer
- Royal North Shore Hospital Sydney Australia.,Kolling Institute of Medical Research University of Sydney Sydney Australia
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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.
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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
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15
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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.
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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
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