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Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials.

Forsetlund L, Eike MC, Gjerberg E, Vist GE - BMC Geriatr (2011)

Bottom Line: The purpose of the review was to identify and summarise the effect of interventions aimed at reducing potentially inappropriate use or prescribing of drugs in nursing homes.Several reviews were identified, but these either concerned elderly in general or did not satisfy all the requirements for systematic reviews.Due to poor quality of the evidence, no conclusions may be drawn about the effect of the other three interventions on drug use, or of either intervention on health-related outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Norwegian Knowledge Centre for the Health Services, St. Olavsplass, Oslo, Norway. louise.forsetlund@kunnskapssenteret.no

ABSTRACT

Background: Studies have shown that residents in nursing homes often are exposed to inappropriate medication. Particular concern has been raised about the consumption of psychoactive drugs, which are commonly prescribed for nursing home residents suffering from dementia. This review is an update of a Norwegian systematic review commissioned by the Norwegian Directorate of Health. The purpose of the review was to identify and summarise the effect of interventions aimed at reducing potentially inappropriate use or prescribing of drugs in nursing homes.

Methods: We searched for systematic reviews and randomised controlled trials in the Cochrane Library, MEDLINE, EMBASE, ISI Web of Knowledge, DARE and HTA, with the last update in April 2010. Two of the authors independently screened titles and abstracts for inclusion or exclusion. Data on interventions, participants, comparison intervention, and outcomes were extracted from the included studies. Risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Table and GRADE, respectively. Outcomes assessed were use of or prescribing of drugs (primary) and the health-related outcomes falls, physical limitation, hospitalisation and mortality (secondary).

Results: Due to heterogeneity in interventions and outcomes, we employed a narrative approach. Twenty randomised controlled trials were included from 1631 evaluated references. Ten studies tested different kinds of educational interventions while seven studies tested medication reviews by pharmacists. Only one study was found for each of the interventions geriatric care teams, early psychiatric intervening or activities for the residents combined with education of health care personnel. Several reviews were identified, but these either concerned elderly in general or did not satisfy all the requirements for systematic reviews.

Conclusions: Interventions using educational outreach, on-site education given alone or as part of an intervention package and pharmacist medication review may under certain circumstances reduce inappropriate drug use, but the evidence is of low quality. Due to poor quality of the evidence, no conclusions may be drawn about the effect of the other three interventions on drug use, or of either intervention on health-related outcomes.

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Related in: MedlinePlus

Flow chart of study selection.
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Figure 1: Flow chart of study selection.

Mentions: We identified and assessed 1631 references (205 of these from the update search) by title and abstract according to inclusion and exclusion criteria. Of these, 57 references (15 from the update) were further evaluated for inclusion in full-text. Twenty-one publications (2 from the update) of 20 randomised controlled trials met the inclusion criteria [10-30], 15 of which were randomized by clusters. A flow diagram of the selection process is presented in Figure 1. None of the 19 identified review articles were included in this paper, as they either failed to meet the inclusion criteria of high quality systematic reviews or because they reviewed studies of elderly in general. Detailed reasons for exclusions of reviews and randomised controlled trials are reported in 'Excluded Studies' in Additional file 1, Table S2.


Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials.

Forsetlund L, Eike MC, Gjerberg E, Vist GE - BMC Geriatr (2011)

Flow chart of study selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108292&req=5

Figure 1: Flow chart of study selection.
Mentions: We identified and assessed 1631 references (205 of these from the update search) by title and abstract according to inclusion and exclusion criteria. Of these, 57 references (15 from the update) were further evaluated for inclusion in full-text. Twenty-one publications (2 from the update) of 20 randomised controlled trials met the inclusion criteria [10-30], 15 of which were randomized by clusters. A flow diagram of the selection process is presented in Figure 1. None of the 19 identified review articles were included in this paper, as they either failed to meet the inclusion criteria of high quality systematic reviews or because they reviewed studies of elderly in general. Detailed reasons for exclusions of reviews and randomised controlled trials are reported in 'Excluded Studies' in Additional file 1, Table S2.

Bottom Line: The purpose of the review was to identify and summarise the effect of interventions aimed at reducing potentially inappropriate use or prescribing of drugs in nursing homes.Several reviews were identified, but these either concerned elderly in general or did not satisfy all the requirements for systematic reviews.Due to poor quality of the evidence, no conclusions may be drawn about the effect of the other three interventions on drug use, or of either intervention on health-related outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Norwegian Knowledge Centre for the Health Services, St. Olavsplass, Oslo, Norway. louise.forsetlund@kunnskapssenteret.no

ABSTRACT

Background: Studies have shown that residents in nursing homes often are exposed to inappropriate medication. Particular concern has been raised about the consumption of psychoactive drugs, which are commonly prescribed for nursing home residents suffering from dementia. This review is an update of a Norwegian systematic review commissioned by the Norwegian Directorate of Health. The purpose of the review was to identify and summarise the effect of interventions aimed at reducing potentially inappropriate use or prescribing of drugs in nursing homes.

Methods: We searched for systematic reviews and randomised controlled trials in the Cochrane Library, MEDLINE, EMBASE, ISI Web of Knowledge, DARE and HTA, with the last update in April 2010. Two of the authors independently screened titles and abstracts for inclusion or exclusion. Data on interventions, participants, comparison intervention, and outcomes were extracted from the included studies. Risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Table and GRADE, respectively. Outcomes assessed were use of or prescribing of drugs (primary) and the health-related outcomes falls, physical limitation, hospitalisation and mortality (secondary).

Results: Due to heterogeneity in interventions and outcomes, we employed a narrative approach. Twenty randomised controlled trials were included from 1631 evaluated references. Ten studies tested different kinds of educational interventions while seven studies tested medication reviews by pharmacists. Only one study was found for each of the interventions geriatric care teams, early psychiatric intervening or activities for the residents combined with education of health care personnel. Several reviews were identified, but these either concerned elderly in general or did not satisfy all the requirements for systematic reviews.

Conclusions: Interventions using educational outreach, on-site education given alone or as part of an intervention package and pharmacist medication review may under certain circumstances reduce inappropriate drug use, but the evidence is of low quality. Due to poor quality of the evidence, no conclusions may be drawn about the effect of the other three interventions on drug use, or of either intervention on health-related outcomes.

Show MeSH
Related in: MedlinePlus