Carolina Tisnado Garland1, Line Guénette2, Edeltraut Kröger3, Pierre-Hugues Carmichael4, Rachel Rouleau5, Caroline Sirois6. 1. Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), CIUSSS of the Capitale-Nationale, Quebec City, Quebec, Canada. 2. Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada; CHU de Québec Research Centre, Population Health and Optimal Health Practices Research Unit, Quebec City, Quebec, Canada. 3. Centre d'excellence sur le vieillissement de Québec (CEVQ), CIUSSS of the Capitale-Nationale, Quebec City, Quebec, Canada; Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada. 4. Centre d'excellence sur le vieillissement de Québec (CEVQ), CIUSSS of the Capitale-Nationale, Quebec City, Quebec, Canada. 5. Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Quebec City, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec City, Quebec, Canada. 6. Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), CIUSSS of the Capitale-Nationale, Quebec City, Quebec, Canada. Electronic address: caroline.sirois@fmed.ulaval.ca.
Abstract
OBJECTIVES: Assess the impact of a new pharmaceutical care model on (1) polypharmacy and (2) potentially inappropriate medication (PIM) use in long-term care facilities (LTCFs). DESIGN: Pragmatic quasi-experimental study with a control group. This multifaceted model enables pharmacists and nurses to increase their professional autonomy by enforcing laws designed to expand their scope of practice. It also involves a strategic reorganization of care, interdisciplinary training, and systematic medication reviews. SETTING AND PARTICIPANTS: Two LTCFs exposed to the model (409 residents) were compared to 2 control LTCFs (282 residents) in Quebec, Canada. All individuals were aged 65 years or older and residing in included LTCFs. MEASURES: Polypharmacy (≥10 medications) and PIM (2015 Beers criteria) were analyzed throughout 12 months between March 2017 and June 2018. Groups were compared before and after implementation using repeated measures mixed Poisson or logistic regression models, adjusting for potential confounding variables. RESULTS: Over 12 months, for regular medications, polypharmacy decreased from 42% to 20% (exposed group) and from 50% to 41% (control group) [difference in differences (DID): 13%, P < .001]. Mean number of PIMs also decreased from 0.79 to 0.56 (exposed group) and from 1.08 to 0.90 (control group) (DID: 0.05, P = .002). CONCLUSIONS AND IMPLICATIONS: Compared with usual care, this multifaceted model reduced the probability of receiving ≥10 medications and the mean number of PIMs. Greater professional autonomy, reorganization of care, training, and medication review can optimize pharmaceutical care. As the role of pharmacists is expanding in many countries, this model shows what could be achieved with increased professional autonomy of pharmacists and nurses in LTCFs.
OBJECTIVES: Assess the impact of a new pharmaceutical care model on (1) polypharmacy and (2) potentially inappropriate medication (PIM) use in long-term care facilities (LTCFs). DESIGN: Pragmatic quasi-experimental study with a control group. This multifaceted model enables pharmacists and nurses to increase their professional autonomy by enforcing laws designed to expand their scope of practice. It also involves a strategic reorganization of care, interdisciplinary training, and systematic medication reviews. SETTING AND PARTICIPANTS: Two LTCFs exposed to the model (409 residents) were compared to 2 control LTCFs (282 residents) in Quebec, Canada. All individuals were aged 65 years or older and residing in included LTCFs. MEASURES: Polypharmacy (≥10 medications) and PIM (2015 Beers criteria) were analyzed throughout 12 months between March 2017 and June 2018. Groups were compared before and after implementation using repeated measures mixed Poisson or logistic regression models, adjusting for potential confounding variables. RESULTS: Over 12 months, for regular medications, polypharmacy decreased from 42% to 20% (exposed group) and from 50% to 41% (control group) [difference in differences (DID): 13%, P < .001]. Mean number of PIMs also decreased from 0.79 to 0.56 (exposed group) and from 1.08 to 0.90 (control group) (DID: 0.05, P = .002). CONCLUSIONS AND IMPLICATIONS: Compared with usual care, this multifaceted model reduced the probability of receiving ≥10 medications and the mean number of PIMs. Greater professional autonomy, reorganization of care, training, and medication review can optimize pharmaceutical care. As the role of pharmacists is expanding in many countries, this model shows what could be achieved with increased professional autonomy of pharmacists and nurses in LTCFs.
Authors: Barbara Resnick; Sheryl Zimmerman; Joseph Gaugler; Joseph Ouslander; Kathleen Abrahamson; Nicole Brandt; Cathleen Colón-Emeric; Elizabeth Galik; Stefan Gravenstein; Lona Mody; Philip D Sloane; Kathleen Unroe; Hilde Verbeek Journal: J Am Geriatr Soc Date: 2022-02-23 Impact factor: 5.562
Authors: Barbara Resnick; Sheryl Zimmerman; Joseph Gaugler; Joseph Ouslander; Kathleen Abrahamson; Nicole Brandt; Cathleen Colón-Emeric; Elizabeth Galik; Stefan Gravenstein; Lona Mody; Philip D Sloane; Kathleen Unroe; Hilde Verbeek Journal: J Am Med Dir Assoc Date: 2022-03 Impact factor: 7.802