The interest in improving the pharmacotherapy of older adults in nursing homes is growing. We propose a method intending to support the decision of GPs regarding the pharmacotherapy of older adults. To achieve this, we introduce the OptiMEDs intervention: a combination of an electronic decision support tool (for the appraisal of potentially inappropriate medication use, anticholinergic use, or medications that can be de-prescribed in view of limited life expectancy) with focussed nurse observations (guided by a list of potential medication symptoms based on the individual medication chart of the resident), that will serve as the basis for a multidisciplinary medication review with the input of the GP, community pharmacist and nurse. By using the OptiMEDs intervention, we expect to obtain a more appropriate, safer, and more cost-effective pharmacotherapy in nursing home residents (e.g. less medication-related symptoms, less potentially inappropriate prescribing, a better quality of life, less hospitalisations, health care usage, or mortality)
Before investigating the effectiveness of the OptiMEDs intervention in a large pragmatic clinical trial comparing results of the intervention with standard of care, we will performing a pilot study in 3 nursing homes aiming to study the feasibility and acceptability of all components included in OptiMEDs.
| Summary of results |
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A total of 148 participants, residing in 3 nursing homes, provided informed consent. Participants had a mean age of 87.2 years (range 67-101), with 75% being female and 51% suffering with dementia. The average number of medications varied between nursing homes (range 5.6 - 7.6). At least one ‘possible inappropriate medication’ was found in 93% of the participants. During observation by the nurse 83% of the residents in the intervention arm (N=100) had symptoms (range 1-19) potentially related to medications. Pharmacists gave advice to 44% of the residents and the GP (family doctor) changed at least one prescription in 34% of residents. There was a decrease of at least one medication in 36% of residents and at least one ‘possible inappropriate medication’ in 26% of residents in the intervention arm. Medication reviews supported by the OptiMEDs tool proved to be a user-friendly, and potentially time-saving method to involve all health-care professionals during a medication review. This pilot study supports the need for a larger trial of the wider implementation of the OptiMEDs tool in Belgian nursing homes in order to improve geriatric pharmacotherapeutic care in this frail population. |
| Title | Pilot study of the OptiMEDs intervention: a complex intervention for multidisciplinary medication review (including nurses, pharmacists, and physicians) in nursing homes, with ICT-support for the evaluation of the appropriateness of prescribing and for side-effect monitoring KCE-17008 |
| Participants (P) | Residents in nursing homes |
| Intervention (I) | Formalised medication review involving input from nurses, pharmacist and GP supported by an electronic tool |
| Control (C) | Medication review as performed according to usual care |
| Outcome (O) | The feasibility and acceptability of a full study to investigate whether NH residents receiving standardised multidisciplinary medication review (prepared by ICT-support) will use less inappropriate medication four months after the intervention, compared to residents receiving standard care medication review. |
| Trial Design | Pilot study |
| Sample Size | estimated 150 residents |
| Trial duration | 11 months |
| Budget | € 450,000 including VAT (375,000 excluding VAT) |
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Sponsor |
Ghent University |
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Chief Investigator |
Prof. Thierry Christiaens
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Trial coordinator |
Maarten Wauters
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Sites |
3 nursing homes (1 control & 2 intervention) |
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External Partners |
Research in Advanced Medical Informatics and Telematics (RAMIT) vzw University Antwerpen |
Clinicaltrials.gov: NCT04142645
Investigator-led workstream 2017
