No impact of a prescription booklet on medication consumption in nursing home residents from 2011 to 2014: a controlled before–after study

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Abstract

Background

Older persons are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. We aimed to evaluate the impact on medication consumption, of a booklet designed to aid physicians with prescriptions for elderly nursing home residents.

Methods

Among 519 nursing homes using an electronic pill dispenser, we recorded the daily number of times that a drug was administered for each resident, over a period of 4 years. The intervention group comprised 113 nursing homes belonging to a for-profit geriatric care provider that implemented a booklet delivered to prescribers and pharmacists and specifically designed to aid with prescriptions for elderly nursing home residents. The remaining 406 nursing homes where no such booklet was introduced comprised the control group. Data were derived from electronic pill dispensers. The effect of the intervention on medication consumption was assessed with multilevel regression models, adjusted for nursing home status. The main outcomes were the average daily number of times that a medication was administered and the number of drugs with different presentation identifier codes per resident per month.

Results

96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (− 0.05 and − 0.06). The booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99–1.02, P = .45).

Conclusion

We observed an overall decrease in medication consumption in both the control and intervention groups. Our analysis did not provide any evidence that this reduction was related to the use of the booklet. Other factors, such as national policy or increased physician awareness, may have contributed to our findings.

Electronic supplementary material

The online version of this article (10.1007/s40520-020-01670-5) contains supplementary material, which is available to authorized users.

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Most cited references 45

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Adherence to Medication

Lars Osterberg, Terrence F. Blaschke (2005)

New England Journal of Medicine, 353(5), 487-497

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What is polypharmacy? A systematic review of definitions

Nashwa Masnoon, Sepehr Shakib, Lisa Kalisch-Ellett … (2017)

Background Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. Methods The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). Results A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Conclusions Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.

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Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

Donna M Fick, James W. Cooper, William Wade … (2003)

Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States. This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions. This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.

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Author and article information

Contributors

Fiona Ecarnot:

ORCID: http://orcid.org/0000-0002-4224-9731

fiona.ecarnot@univ-fcomte.fr

Journal

Journal ID (nlm-ta): Aging Clin Exp Res

Journal ID (iso-abbrev): Aging Clin Exp Res

Title: Aging Clinical and Experimental Research

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1594-0667

ISSN (Electronic): 1720-8319

Publication date (Electronic): 3 August 2020

Publication date PMC-release: 3 August 2020

Publication date (Print): 2021

Volume: 33

Issue: 6

Pages: 1599-1607

Affiliations

[1 ]Fondation Korian Pour le Bien Vieillir, 25 Rue Balzac, 75008 Paris, France

[2 ]GRID grid.440376.2, ISNI 0000 0004 0594 4000, Centre Hospitalier de Troyes, Pôle Information Médicale Évaluation Performance, ; 101 Av Anatole France, 10000 Troyes, France

[3 ]GRID grid.413852.9, ISNI 0000 0001 2163 3825, Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, ; 162 Av Lacassagne, 69003 Lyon, France

[4 ]GRID grid.12832.3a, ISNI 0000 0001 2323 0229, Université de Versailles Saint Quentin, UMR 1168 Vieillissement et Maladies chroniques, Approches épidémiologique et de santé publique, ; 16 Av Paul Vaillant Couturier, 94807 Villejuif, France

[5 ]GRID grid.411158.8, ISNI 0000 0004 0638 9213, Department of Cardiology, , University Hospital Jean Minjoz, ; Boulevard Fleming, 25000 Besançon, France

[6 ]GRID grid.5613.1, ISNI 0000 0001 2298 9313, EA3920, University of Burgundy Franche-Comté, ; 19 Rue Ambroise Paré, 25000 Besançon, France

[7 ]Medissimo, 8 Rue Charles Edouard Jeanneret, 78300 Poissy, France

[8 ]GRID grid.414215.7, ISNI 0000 0004 0639 4792, Department of Geriatrics and Internal Medicine, , Maison Blanche Hospital, Reims University Hospitals, ; 45 Rue Cognacq-Jay, 51000 Reims, France

[9 ]GRID grid.11667.37, ISNI 0000 0004 1937 0618, Faculty of Medicine, , University of Reims Champagne-Ardenne, ; 51 Rue Cognacq-Jay, 51100 Reims, France

Author information

Fiona Ecarnot http://orcid.org/0000-0002-4224-9731

Article

Publisher ID: 1670

DOI: 10.1007/s40520-020-01670-5

PMC ID: 8203501

PubMed ID: 32748114

SO-VID: f34fee32-2274-45dc-9cae-47a521ec47c4

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 22 May 2020

Date accepted : 23 July 2020

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Keywords: polypharmacy,nursing homes,geriatrics,health policy

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Keywords: polypharmacy, nursing homes, geriatrics, health policy

No impact of a prescription booklet on medication consumption in nursing home residents from 2011 to 2014: a controlled before–after study

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Most cited references 45

Adherence to Medication

What is polypharmacy? A systematic review of definitions

Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

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