Impact of a pharmacist-administered deprescribing intervention on nursing home residents: A randomized controled trial
Canadian Pharmacists Conference ePoster Library. Balsom C. Jun 3, 2018; 217829
Dr. Catherine Balsom
Dr. Catherine Balsom
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Abstract
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OBJECTIVES: To implement and assess a deprescribing initiative designed to safely reduce the number of unnecessary medications among long term care (LTC) residents in Newfoundland and Labrador. Secondary objectives assessed the impact of deprescribing on resident survival, cognitive performance and disablement. METHODS: St Patrick's Mercy Home is a 210 bed LTC facility. Residents on one unit were randomized to receive a deprescribing intervention or serve as a control. Staff were educated about deprescribing and non-pharmacologic supports before the study began. The intervention group received an in-depth, medication review by a pharmacist. Individualized plans to taper and discontinue medications were developed and discussed with prescribing physicians and the resident/family. The total number of prescribed regular and as-needed medications were measured at baseline, three months and six months. Resident Assessment Instrument (RAI) scales, including Cognitive Performance and Activities of Daily Living (disablement), were also measured. RESULTS: Sixty-six residents were eligible; 42 enrolled (n=20 intervention, n=22 control). Mean age was 84 years for both groups. At baseline, mean number of medications was 15 for the intervention and 14.55 for the control. The intervention group experienced a significant decrease of 2.45 medications at three months compared to a 0.23 increase in the control group (p < 0.01). A significant difference was also found at six months; the intervention group decreased by 2.78 medications and the control group increased by 0.05 (p < 0.01). Seven participants died during the study (n=4 intervention, n=3 control). No deaths were attributed to the intervention. No significant changes in cognitive performance or disablement were found in either group over the course of the study (p > 0.05). CONCLUSIONS: The deprescribing intervention successfully reduced the number of medications taken by nursing home residents. No impact was found on cognitive function or survival in this pilot study. Expansion to additional floors is planned.
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