[Effect of interventions to reduce potentially inappropriate use of medicines in nursing homes: a systematic review of randomised controlled trials]

Forsetlund L, Eike MC, Gjerberg E, Vist G
Record ID 32010001803
English, Norwegian
Authors' recomendations: Educational outreach or educational interventions given alone or as part of a complex package aimed at health professionals may in some contexts reduce inappropriate drug use. The quality of evidence for these results in a nursing home setting varies from very low to low.Medical review by pharmacists in an interdisciplinary collaboration with the nursing home physician and other relevant health professionals seems in some contexts to reduce inappropriate drug use. The quality of evidence for these results varies from very low to low.A geriatric assessment team responsible for all medical treatment of the elderly demonstrated a statistical significant effect on prescribing of drugs in one study. The study had few participants and a high risk of bias in the results. The evidence is therefore of too low quality for judging whether the intervention affects inappropriate use of medicines.Early psychiatric intervening had no statistically significant effect on the use of psychoactive drugs. Since the quality of the evidence for this result is very low, we cannot determine whether the intervention affects the use of drugs or not.Activating residents combined with educational meetings for health personnel had no statistically significant effect on the use of antipsychotics or the number of drugs used in total. Since the quality of the evidence for this result is very low, we cannot determine whether the intervention affects the use of drugs or not.The quality of the evidence is too low to assess whether interventions to reduce inappropriate medication affects health outcomes.To increase the confidence in the results from the interventions that we included, it is necessary to conduct additional large enough studies with rigorous design ro reduce the risk of bias. With the large universal body of evidence of the effect of educational interventions in mind, there is no need for more research on general educational interventions alone. More research on medical review by a pharmacist with a passive response to the doctor is probably not very fruitful. Apart from the interventions that we identified, additional interventions that could be of interest to test for their effect on use or prescription of drugs are for example environmental and activation interventions, including interventions that test the effect of increased staffing of physicians and/or other health care professionals.
Details
Project Status: Completed
Year Published: 2010
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Norway
MeSH Terms
  • Drug Prescriptions
  • Drug Therapy
  • Drug Utilization
  • Homes for the Aged
  • Medication Errors
  • Nursing Homes
  • Pharmaceutical Preparations
  • Quality Assurance, Health Care
Contact
Organisation Name: Norwegian Institute of Public Health
Contact Address: Universitetsgata 2, Postbox 7004 St. Olavs plass, NO-0310 Oslo NORWAY. Tel: +47 23 25 50 00; Fax: +47 23 25 50 10;
Contact Name: Berit.Morland@nokc.no, dagny.fredheim@nokc.no
Contact Email: Berit.Morland@nokc.no, dagny.fredheim@nokc.no
Copyright: Norwegian Knowledge Centre for the Health Services (NOKC)
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