Discontinuing Inappropriate Medication Use in Nursing Home Residents (DIM NHR Study) Hans Wouters, Sytse Zuidema, Froukje Boersma, Katja Taxis
CONFLICT OF INTEREST DISCLOSURE I have no potential conflict of interest to report
Problem definition
Inappropriate prescribing in 40% inappropriate nursing home residents is common Gallagher et al., J Clin Phar Ther 2007, Davidoff et al., JAGS 2015
Study Aim
Few deprescribing interventions available
Approach
Cluster Randomized Controlled Trial Elder Care Physician & Intervention Control Wards Nursing Home Residents
Study Overview Conduct Educate Foll llow-up up Medication data physicians colle llection Reviews In Inclu lusion & Prepare Monitor Baselin ine Medication data Adherence coll llection Reviews
Medication Review: Steps Assessing Patient Perspective
Primary Outcome: Successful Discontinuation of ≥1 inappropriate drugs
Secondary Outcomes: Pharmacologic: Clinical: • • Initiation of Fall incidents • underprescribed drugs Visits outpatient clinics • • Dose adjustments Consultations Healthcare • Safer alternatives Professionals • • Drug Burden Index Cognitive Function • Neuropsychiatric Symptoms • Quality of Life
Results
Key data on DIM NHR Study Variable Control Intervention N Residents 193 233 N Wards 26 33 Female % 71 65 Dementia % 45 43 M Age y 83.2 ± 8.9 83.7 ± 7.5 M Charlson 2.0 ± 1.4 2.0 ± 1.5 M LOS mo 34 ± 26.3 34.5 ± 31.9
Random in intercept analy lysis: : % residents ≥1 successfully discontinued drugs % 39.1 % Intervention group vs. 29.5% control group: Adjusted * relative risk: 1.37, (95% confidence interval 1.02-1.75) Adjusted for sex, age, marital status, length of stay, Charlson’s co -morbidity, and dementia diagnosis
Types of succesfully discontinued drugs Number of successfully discontinued drugs Control Intervention Alimentary tract (A0 A1) 23 33 Anti-thrombotic agents (B0) 9 24 Cardiovascular drugs (C0 C1) 16 25 Sex hormones/ urologicals (G0) 3 5 Systemic Corticosteroids (H0) 0 1 Systemic anti-bacterials (J0) 0 2 Immunosuppressants (L0) 0 1 Anti-rheumatic drugs (M0) 7 10 Psychotropic drugs (N0) 24 48 Pulmonary (R0) 4 8 Ophthalmologicals (S0) 2 3 Other therapeutic drugs 5 2
No significant effects on secondary pharmacological and clinical outcomes
Conclusions
2 Take Home Messages Medication reviews have additional value Discontinuing inappropriate medication does not seem to compromise nursing home residents’ wellbeing
Thank you Nous remercions l’organisation d’EUGMS d’avoir choisi notre résumé pour présentation
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