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

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 definition

Inappropriate prescribing in 40% inappropriate nursing home residents is common Gallagher et al., J Clin Phar Ther 2007, Davidoff et al., JAGS 2015

Study Aim

Few deprescribing interventions available

Approach

Cluster Randomized Controlled Trial Elder Care Physician & Intervention Control Wards Nursing Home Residents

Study Overview Conduct Educate Foll llow-up up Medication data physicians colle llection Reviews In Inclu lusion & Prepare Monitor Baselin ine Medication data Adherence coll llection Reviews

Medication Review: Steps Assessing Patient Perspective

Primary Outcome: Successful Discontinuation of ≥1 inappropriate drugs

Secondary Outcomes: Pharmacologic: Clinical: • • Initiation of Fall incidents • underprescribed drugs Visits outpatient clinics • • Dose adjustments Consultations Healthcare • Safer alternatives Professionals • • Drug Burden Index Cognitive Function • Neuropsychiatric Symptoms • Quality of Life

Results

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

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

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) 0 1 Systemic anti-bacterials (J0) 0 2 Immunosuppressants (L0) 0 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

No significant effects on secondary pharmacological and clinical outcomes

Conclusions

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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