Inappropriate Medication Use in Nursing Home Residents (DIM NHR - - PowerPoint PPT Presentation

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Nov 27, 2022 18 likes •219 views

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

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Discontinuing Inappropriate Medication Use in Nursing Home Residents (DIM NHR Study)

Hans Wouters, Sytse Zuidema, Froukje Boersma, Katja Taxis

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CONFLICT OF INTEREST DISCLOSURE I have no potential conflict

f interest to report

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Problem definition

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Inappropriate prescribing in nursing home residents is common

Gallagher et al., J Clin Phar Ther 2007, Davidoff et al., JAGS 2015

40% inappropriate

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Study Aim

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Few deprescribing interventions available

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Approach

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Cluster Randomized Controlled Trial

Control Elder Care Physician & Wards Nursing Home Residents Intervention

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Study Overview

Conduct Medication Reviews Prepare Medication Reviews Educate physicians Monitor Adherence

In Inclu lusion & Baselin ine data coll llection

Foll llow-up up data colle llection

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Medication Review: Steps

Assessing Patient Perspective

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Primary Outcome: Successful Discontinuation

f ≥1 inappropriate drugs

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Clinical:

Fall incidents
Visits outpatient clinics
Consultations Healthcare

Professionals

Cognitive Function
Neuropsychiatric

Symptoms

Quality of Life

Secondary Outcomes:

Pharmacologic:

Initiation of

underprescribed drugs

Dose adjustments
Safer alternatives
Drug Burden Index

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Results

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Key data on DIM NHR Study

Intervention 233 33 65 43 83.7 ± 7.5 2.0 ± 1.5 34.5 ± 31.9 Control 193 26 71 45 83.2 ± 8.9 2.0 ± 1.4 34 ± 26.3 Variable N Residents N Wards Female % Dementia % M Age y M Charlson M LOS mo

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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

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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) 1 Systemic anti-bacterials (J0) 2 Immunosuppressants (L0) 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

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No significant effects on secondary pharmacological and clinical outcomes

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Conclusions

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2 Take Home Messages

Medication reviews have additional value Discontinuing inappropriate medication does not seem to compromise nursing home residents’ wellbeing

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Thank you

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