This study aims to examine the efficacy and cost-efficacy of multidisciplinary systematic medication reviews.
ID
Source
Brief title
Condition
- Other condition
Synonym
Health condition
polyfarmacie
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The difference in the proportion of residents for whom inappropriate medication
will be discontinued (intervention group versus control group).
Secondary outcome
Underprescribing; Exposure to anticholinergic and sedative medication; side
effecs of medication; neuropsychiatric symptoms; cognitive function; quality of
life; hospital admissions; mortality risk.
Background summary
Nursing home residents are a frail patient group who often have multimorbidity
which results in use of multiple drugs at the same time or polypharmacy.
Polypharmacy may reflect inappropriate prescribing e.g. overprescribing but
also underprescribing. Polypharmacy increases the occurence of side effects,
increases the fall risk, hospital admission, health care utilization and
mortality. Multidisciplinary systematic medication reviews provide an
opportunity to decrease inappropriate prescribing. However, the efficacy and
cost-efficacy of medication reviews have not yet been examined in the Dutch
nursing home setting.
Study objective
This study aims to examine the efficacy and cost-efficacy of multidisciplinary
systematic medication reviews.
Study design
A cluster randomized controlled trial in nursing homes. Randomization takes
place at the level of the ward. The nursing home wards form the custers. Data
will be collected at baseline and at follow-up or four months after the
medication review has taken place.
Intervention
Multidisciplinary systematic medication reviews are the interventions that will
be examined in this study.These medication reviews are based on
multidisciplinary guidelines of the Dutch association of general practitioners
and the Dutch association of elderly care physicians. Multidisciplinary
systematic medication reviews are carried out by a elderly care physician and a
hospital pharmacist. On clinical indication, a medical specialist will be
consulted.
Study burden and risks
Participants or their legal representatives will be informed about the study.
Informed Consent will be asked from every participant or his/her legal
representative. Data will be processed anonymously. Only the physician and the
researcher will have acces to the data. If required, the Dutch Inspection of
Healthcare will also be granted access to the data for inspection. The burden
of participation will be constrained to a minimum by trying to retrieve as much
information from patients' medical records as possible and by using
questionnaires and tests that were specifically developed for the nursing home
population. In our opinion, participation does not involve risks.
Multidisciplinary systematic medication reviews are aimed at improving the
advice to the elderly care physician. Final decisions concerning treatment will
rest with the elderly care physician though.Medication reviews have much to
offer to frail nursing home residents as they have the potential to reduce
inappropriate prescribing i.e. overprescribing as well as underprescribing.
Polypharmacy, possibly resulting from overtreatment and inappropriate
prescribing, is a significant problem in this group of patients. Polypharmacy
increases the occurence of side effects, increases the fall risk, hospital
admission, health care utilization and mortality. We expect medication reviews
to improve nursing home residents' health and quality of life significantly.
Antonius Deusinglaan 1
Groningen 9713 AV
NL
Antonius Deusinglaan 1
Groningen 9713 AV
NL
Listed location countries
Age
Inclusion criteria
Nursing Home Ward Level:;• Long stay ward.
• Capability and commitment to perform a multidisciplinary multistep medication review in the way as outlined in paragraph 4.1 Treatment of the study protocol. ;Nursing Home Residents Level:;• A life expectancy of >4 weeks as judged by the treating elderly care physician.
• IC provided by patients themselves or provided by a legal representative of incapacitated patients.
Exclusion criteria
Nursing Home Ward Level:;• Short stay, revalidation or observation wards as including these will inflate the rate of patients who are lost to follow-up.
• Specialized ward where patients with an atypical etiology e.g. lifespan psychiatric illness, alcohol dementia, AIDS, and mental disability are cared for.
• Elderly care physicians who have recently received or who are to receive recertification at short notice with regard to systematic medication review methodology.
• Participation in other studies aimed at improving the quality of drug prescription (in the past 12 months).;Nursing Home Residents Level:;• Refusal of treatment with medicines.
• Having received a multidisciplinary systematic medication review in the past 6 months.
• Being terminally ill and having a life expectancy <= 4 weeks as judged by the treating elderly care physician.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| ClinicalTrials.gov | NCT01876095 |
| CCMO | NL48091.042.14 |