Goedele Strauven1, Pauline Anrys2, Eline Vandael1, Séverine Henrard3, Jan De Lepeleire4, Anne Spinewine5, Veerle Foulon6. 1. KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium. 2. UC Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Brussels, Belgium. 3. UC Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Brussels, Belgium; UC Louvain, Institute of Health and Society, Brussels, Belgium. 4. KU Leuven, Department Public Health and Primary Care, ACHG, Leuven, Belgium. 5. UC Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Brussels, Belgium; UC Louvain, CHU UCL Namur, Pharmacy Department, Yvoir, Belgium. 6. KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium. Electronic address: veerle.foulon@kuleuven.be.
Abstract
OBJECTIVES: To investigate the impact of a complex multifaceted intervention on the appropriateness of prescribing for Belgian nursing home (NH) residents. DESIGN: A multicenter, nonblinded, cluster-randomized controlled trial, with randomization at the NH level, was set up [Cluster-Controlled Trial of an Intervention to Improve Prescribing in Nursing Homes (COME-ON) Study]. The complex intervention consisted of repeated interdisciplinary case conferences (ICCs) involving the general practitioner, pharmacist, and nurse, aimed at performing a medication review for each NH resident included. The ICCs were supported by a blended training program and local interdisciplinary meetings (discussion of the appropriate use of specific medication classes at the NH level). Control NHs delivered usual care. (isrctn.com: ISRCTN66138978). SETTING AND PARTICIPANTS: Belgian NHs with at least 35 NH residents were eligible to participate. Eligible residents were those aged 65 years or over, not receiving palliative care, and being treated by a participating general practitioner. MEASURES: The primary outcome measure related to appropriateness of prescribing at resident level and was considered successful when at least 1 potentially inappropriate medication (PIM) or potential prescribing omission (PPO) present at baseline had been solved at the end of study and when there were no new PIMs or PPOs at the end of study compared with baseline. Secondary outcomes included clinical outcomes, medication use, criterion-specific prevalence of PIMs and PPOs, and ICC outcomes. RESULTS:In total, 54 NHs (24 intervention; 30 control) and 1804 NH residents (847 intervention; 957 control) participated. Using a 3-level mixed-effects model accounting for data clustering, a significant effect in favor of the intervention was observed (odds ratio 1.479 [95% confidence interval 1.062-2.059, P = .021]). There was no significant difference between groups for most clinical outcomes. The median number of medications did not change over time in either group. CONCLUSIONS AND IMPLICATIONS: The complex multifaceted intervention tested in the COME-ON study successfully improved appropriateness of prescribing in NHs.
RCT Entities:
OBJECTIVES: To investigate the impact of a complex multifaceted intervention on the appropriateness of prescribing for Belgian nursing home (NH) residents. DESIGN: A multicenter, nonblinded, cluster-randomized controlled trial, with randomization at the NH level, was set up [Cluster-Controlled Trial of an Intervention to Improve Prescribing in Nursing Homes (COME-ON) Study]. The complex intervention consisted of repeated interdisciplinary case conferences (ICCs) involving the general practitioner, pharmacist, and nurse, aimed at performing a medication review for each NH resident included. The ICCs were supported by a blended training program and local interdisciplinary meetings (discussion of the appropriate use of specific medication classes at the NH level). Control NHs delivered usual care. (isrctn.com: ISRCTN66138978). SETTING AND PARTICIPANTS: Belgian NHs with at least 35 NH residents were eligible to participate. Eligible residents were those aged 65 years or over, not receiving palliative care, and being treated by a participating general practitioner. MEASURES: The primary outcome measure related to appropriateness of prescribing at resident level and was considered successful when at least 1 potentially inappropriate medication (PIM) or potential prescribing omission (PPO) present at baseline had been solved at the end of study and when there were no new PIMs or PPOs at the end of study compared with baseline. Secondary outcomes included clinical outcomes, medication use, criterion-specific prevalence of PIMs and PPOs, and ICC outcomes. RESULTS: In total, 54 NHs (24 intervention; 30 control) and 1804 NH residents (847 intervention; 957 control) participated. Using a 3-level mixed-effects model accounting for data clustering, a significant effect in favor of the intervention was observed (odds ratio 1.479 [95% confidence interval 1.062-2.059, P = .021]). There was no significant difference between groups for most clinical outcomes. The median number of medications did not change over time in either group. CONCLUSIONS AND IMPLICATIONS: The complex multifaceted intervention tested in the COME-ON study successfully improved appropriateness of prescribing in NHs.
Authors: F Lombardi; L Paoletti; B Carrieri; G Dell'Aquila; M Fedecostante; M Di Muzio; A Corsonello; F Lattanzio; A Cherubini Journal: Eur Geriatr Med Date: 2021-03-11 Impact factor: 1.710
Authors: Sebastian Voigt-Radloff; Claudia Bollig; Gabriel Torbahn; Michael Denkinger; Jürgen Bauer Journal: Z Gerontol Geriatr Date: 2020-02 Impact factor: 1.281