Multistep medication review tool may be effective in discontinuing inappropriate prescription use in nursing homes

1. In the nursing home setting, the Multidisciplinary Multistep Medication Review (3MR) was found to be nearly 10% more effective in discontinuing inappropriate prescription use.

2. At follow-up, there was no decline in clinical outcomes compared to baseline, suggesting that the 3MR may be useful for decreasing inappropriate prescription use without a negative clinical effect in nursing home residents.

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Polypharmacy, which is the concurrent prescription of 5 or more long-term medications, is linked to a higher risk of inappropriate prescriptions. In nursing homes, as many as 40% of residents may have at least one inappropriate prescription, which is linked to adverse events and hospitalizations. However, there are few interventions with a focus on the reduction of inappropriate prescriptions. This randomized controlled trial (RCT) of residents from Dutch nursing homes sought to evaluate the effectiveness of the 3MR on the reduction of inappropriate prescription use. The discontinuation of at least one inappropriate prescription was 39.1% and 29.5% in the intervention group and control group, respectively. There was no decline in clinical outcomes compared to baseline, suggesting that the 3MR may be useful for decreasing inappropriate prescription use without a negative clinical effect in nursing home residents.

Strengths of the study include the evaluation of various pharmacologic outcomes as well as the use of multiple nursing homes and standardized medication reviews. Limitations of the study include administration of the 3MR only once and the possibility that signs of withdrawal or relapse may not have been detected.

Click to read the study in Annals of Internal Medicine

Click to read an accompanying editorial in Annals of Internal Medicine

Relevant Reading: Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria

In-Depth [randomized controlled trial]: In this cluster RCT, nursing home residents who consented to being treated with medication and had a life expectancy of at least 4 weeks were selected from 59 Dutch nursing homes. Residents were placed into either an intervention group (n = 233) or a control group (n = 193) and were followed for a mean of 144 days (SD, 21). At 33 nursing homes, 19 elder care physicians administered the 3MR, which included a medical history, medication appraisal, a meeting between the treating physician and the pharmacist, changes in medications, and an evaluation of patient perspective. The 3MR was carried out once, and patients were assessed after 4 months. At 26 nursing homes, 16 elder care physicians used standard procedures. The aim was to cease inappropriate medication during the course of the study and to study the effects on clinical outcomes. The discontinuation of at least one inappropriate prescription was 39.1% (n = 91) and 29.5% (n = 57) in the intervention group and control group, respectively. The adjusted relative risk was 1.37 (95% CI, 1.02 to 1.75), and there was no decline in clinical outcomes compared to baseline.

Image: CC/Wiki

©2017 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.