期刊
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
卷 22, 期 1, 页码 141-147出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jamda.2020.09.039
关键词
Polypharmacy; potentially inappropriate medications; deprescription; long-term care; nursing home
资金
- Ministry of Health and Social Services of Quebec
- Centre de recherche sur les soins et les services de premiere ligne de l'Universite Laval (CERSSPL-UL)
- Canadian Consortium on Neurodegeneration in Aging (CCNA)
- Fondation pour les aines et l'Innovation Sociale (FAIS)
- Baie St-Paul's hospital foundation
- Universite Laval
- Centre d'excellence sur le vieillissement de Quebec (CEVQ)
- Fonds de Recherche du Quebec -Sante (FRQS)
- CERSSPL-UL
The new pharmaceutical care model significantly reduces polypharmacy and potentially inappropriate medication use in long-term care facilities. Reorganizing care and increasing the professional autonomy of healthcare providers can optimize pharmaceutical care.
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 1/4 .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. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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