Interventions to optimise prescribing for older people in care homes
- PMID: 23450597
- DOI: 10.1002/14651858.CD009095.pub2
Interventions to optimise prescribing for older people in care homes
Update in
-
Interventions to optimise prescribing for older people in care homes.Cochrane Database Syst Rev. 2016 Feb 12;2(2):CD009095. doi: 10.1002/14651858.CD009095.pub3. Cochrane Database Syst Rev. 2016. PMID: 26866421 Free PMC article. Review.
Abstract
Background: There is a substantial body of evidence that prescribing for care home residents is suboptimal and requires improvement. Consequently, there is a need to identify effective interventions to optimise prescribing and resident outcomes in this context.
Objectives: The objective of the review was to determine the effect of interventions to optimise prescribing for older people living in care homes.
Search methods: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library (Issue 11, 2012); Cochrane Database of Systematic Reviews, The Cochrane Library (Issue 11, 2012); MEDLINE OvidSP (1980 on); EMBASE, OvidSP (1980 on); Ageline, EBSCO (1966 on); CINAHL, EBSCO (1980 on); International Pharmaceutical Abstracts, OvidSP (1980 on); PsycINFO, OvidSP (1980 on); conference proceedings in Web of Science, Conference Proceedings Citation Index - SSH & Science, ISI Web of Knowledge (1990 on); grey literature sources and trial registries; and contacted authors of relevant studies. We also reviewed the references lists of included studies and related reviews (search period November 2012).
Selection criteria: We included randomised controlled trials evaluating interventions aimed at optimising prescribing for older people (aged 65 years or older) living in institutionalised care facilities. Studies were included if they measured one or more of the following primary outcomes, adverse drug events; hospital admissions;mortality; or secondary outcomes, quality of life (using validated instrument); medication-related problems; medication appropriateness (using validated instrument); medicine costs.
Data collection and analysis: Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. A narrative summary of results was presented.
Main results: The eight included studies involved 7653 residents in 262 (range 1 to 85) care homes in six countries. Six studies were cluster-randomised controlled trials and two studies were patient-randomised controlled trials. The interventions evaluated were diverse and often multifaceted. Medication review was a component of seven studies, three studies involved multidisciplinary case-conferencing, two studies involved an educational element for care home staff and one study evaluated the use of clinical decision support technology. Due to heterogeneity, results were not combined in a meta-analysis. There was no evidence of an effect of the interventions on any of the primary outcomes of the review (adverse drug events, hospital admissions and mortality). No studies measured quality of life. There was evidence that the interventions led to the identification and resolution of medication-related problems. There was evidence from two studies that medication appropriateness was improved. The evidence for an effect on medicine costs was equivocal.
Authors' conclusions: Robust conclusions could not be drawn from the evidence due to variability in design, interventions, outcomes and results. The interventions implemented in the studies in this review led to the identification and resolution of medication-related problems, however evidence of an effect on resident-related outcomes was not found. There is a need for high-quality cluster-randomised controlled trials testing clinical decision support systems and multidisciplinary interventions that measure well-defined, important resident-related outcomes.
Similar articles
-
Interventions to improve the appropriate use of polypharmacy for older people.Cochrane Database Syst Rev. 2018 Sep 3;9(9):CD008165. doi: 10.1002/14651858.CD008165.pub4. Cochrane Database Syst Rev. 2018. Update in: Cochrane Database Syst Rev. 2023 Oct 11;10:CD008165. doi: 10.1002/14651858.CD008165.pub5. PMID: 30175841 Free PMC article. Updated. Review.
-
Interventions to optimise prescribing for older people in care homes.Cochrane Database Syst Rev. 2016 Feb 12;2(2):CD009095. doi: 10.1002/14651858.CD009095.pub3. Cochrane Database Syst Rev. 2016. PMID: 26866421 Free PMC article. Review.
-
Interventions to improve the appropriate use of polypharmacy for older people.Cochrane Database Syst Rev. 2012 May 16;(5):CD008165. doi: 10.1002/14651858.CD008165.pub2. Cochrane Database Syst Rev. 2012. Update in: Cochrane Database Syst Rev. 2014 Oct 07;(10):CD008165. doi: 10.1002/14651858.CD008165.pub3. PMID: 22592727 Updated. Review.
-
Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials.BMC Geriatr. 2011 Apr 17;11:16. doi: 10.1186/1471-2318-11-16. BMC Geriatr. 2011. PMID: 21496345 Free PMC article. Review.
-
Care home versus hospital and own home environments for rehabilitation of older people.Cochrane Database Syst Rev. 2003;(2):CD003164. doi: 10.1002/14651858.CD003164. Cochrane Database Syst Rev. 2003. Update in: Cochrane Database Syst Rev. 2008 Oct 08;(4):CD003164. doi: 10.1002/14651858.CD003164.pub2. PMID: 12804453 Updated. Review.
Cited by
-
Impact of pharmaceutical care integrated at a psychosocial intervention to reduce caregiver's burden in Alzheimer's disease or related dementias: Negative results at 18 months and difficulties to conduct PHARMAID RCT.Contemp Clin Trials Commun. 2023 Apr 22;33:101146. doi: 10.1016/j.conctc.2023.101146. eCollection 2023 Jun. Contemp Clin Trials Commun. 2023. PMID: 37397433 Free PMC article.
-
Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map.Campbell Syst Rev. 2021 Jul 7;17(3):e1175. doi: 10.1002/cl2.1175. eCollection 2021 Sep. Campbell Syst Rev. 2021. PMID: 37051456 Free PMC article.
-
The DynAIRx Project Protocol: Artificial Intelligence for dynamic prescribing optimisation and care integration in multimorbidity.J Multimorb Comorb. 2022 Dec 15;12:26335565221145493. doi: 10.1177/26335565221145493. eCollection 2022 Jan-Dec. J Multimorb Comorb. 2022. PMID: 36545235 Free PMC article.
-
Effects of a comprehensive medication review intervention on health-related quality of life and other clinical outcomes in geriatric outpatients with polypharmacy: A pragmatic randomized clinical trial.Br J Clin Pharmacol. 2022 Jul;88(7):3360-3369. doi: 10.1111/bcp.15287. Epub 2022 Mar 8. Br J Clin Pharmacol. 2022. PMID: 35184324 Free PMC article. Clinical Trial.
-
Medication Review in Preventing Older Adults' Fall-Related Injury: a Systematic Review & Meta-Analysis.Can Geriatr J. 2021 Sep 1;24(3):237-250. doi: 10.5770/cgj.24.478. eCollection 2021 Sep. Can Geriatr J. 2021. PMID: 34484506 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical