Interventions to optimise prescribing in care homes: systematic review.

BACKGROUND: prescribing for older people is a complex process and can elevate the risk of inappropriate prescribing, with potentially severe consequences. With a growing ageing population, strategies to improve prescribing in care homes are essential. Our aim was to review systematically the effects of interventions to optimise prescribing in care homes.
METHOD: databases searched were MEDLINE, EMBASE, International Pharmaceutical Abstracts and the Cochrane Library from 1990. Search terms included were 'nursing home', 'residential home', 'inappropriate prescribing', 'education' and 'intervention'. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale.
RESULTS: the search strategy retrieved 16 studies that met the inclusion criteria. Four intervention strategies were identified: staff education, multi-disciplinary team (MDT) meetings, pharmacist medication reviews and computerised clinical decision support systems (CDSSs). Complex educational programmes that focused on improving patients' behavioural management and drug prescribing were the most studied area, with six of eight studies highlighting an improvement in prescribing. Mixed results were found for pharmacist interventions. CDSSs were evaluated in two studies, with one showing a significant improvement in appropriate drug orders. Two of three studies examining MDT meetings found an overall improvement in appropriate prescribing. A meta-analysis could not be performed due to heterogeneity in the outcome measures.
CONCLUSION: results are mixed and there is no one interventional strategy that has proved to be effective. Nevertheless, education including academic detailing seems to show most promise. A multi-faceted approach and clearer policy guidelines are likely to be required to improve prescribing for these vulnerable patients.