Effect of a geriatric intervention aiming to improve polypharmacy in nursing homes
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BRIEF REPORT
Effect of a geriatric intervention aiming to improve polypharmacy in nursing homes Kamal El Haddad1,3 · Philipe de Souto Barreto1,2 · Clarisse Laffon de Mazieres1 · Yves Rolland1,2 Received: 22 August 2019 / Accepted: 5 December 2019 © European Geriatric Medicine Society 2019
Key summary points Aim The aim of this study was to examine the effect of a global intervention comprising an audit on indicators of quality of care and a collaborative work between a hospital geriatrician and NH staff on reducing polypharmacy among NH residents. Findings Despite the unchanged quantity of prescription with an average mean of eight medications per resident before and after the intervention, this work showed a reduction in the number of psychotropic drugs in both study groups, suggesting that this finding was driven by the global audit and feedback intervention on NH quality indicators. Message Improvement and optimization of medical prescriptions in NHs in both groups suggests a positive impact from the audit and feedback on NH quality of care indicators and might be mainly a consequence of a more determined will and increase motivation among the nursing home staff secondary to the implementation of the audit strategy. Abstract Purpose To examine the effect of an intervention comprising professional support by a geriatrician engaged in a quality care indicators’ audit for nursing home (NH) staff on reducing polypharmacy. Methods Of a total of 3709 NH residents, 90 NHs (2026 residents) were allocated to a light intervention and 85 NHs (1683 residents) to a strong intervention group. Results Mixed-effect linear model found no significant variation in the total number of medications over time (β-coefficient for interaction 0.007, 95% CI − 0.15, 0.16). Within-group-adjusted mean differences showed a statistical decline in the psychotropic medication class (− 0.04 SE 0.02 p 0.03 for the strong intervention group and − 0.06 SE 0.02 p 0.001 for the light intervention group) and a statistically significant increase in the analgesics use. Conclusion The possibility that a simple audit intervention might reduce psychotropic prescriptions deserves further investigation. Keywords Polypharmacy · Nursing home · IQUARE · Individualized prescription adaptation (IPA) · Global intervention
Introduction
* Kamal El Haddad [email protected] 1
Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059 Toulouse, France
2
INSERM U1027, University of Toulouse III, Toulouse, France
3
Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France
In addition to the increased health care expenses, polypharmacy increases the risk of inappropriate medication use [1, 2], functional decline, falls, hospitalization, death and decreasing quality of life [3]. It is clear that interventions aiming at lowering polypharmacy in nursing home (NHs), under the respect of best clinical practice, may have important publi
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