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Interventions to optimise prescribing in care homes: systematic review
Mathumalar Loganathan1, Shonella Singh, Bryony Dean Franklin
1Department of Primary Care and Public Health, Imperial College, Charing Cross Campus, London, UK. m.loganathan08@imperial.ac.uk
Age and Ageing
|January 26, 2011
Summary
Improving medication prescribing for older adults in care homes is crucial. Staff education, particularly academic detailing, shows the most promise for optimizing drug use and patient safety.
Area of Science:
- Geriatric Pharmacology
- Medication Safety
- Healthcare Interventions
Background:
- Prescribing for older adults is complex, increasing risks of inappropriate medication use and adverse events.
- The growing elderly population necessitates improved prescribing strategies, especially within care home settings.
- Systematic review of interventions aims to optimize medication prescribing in care homes.
Purpose of the Study:
- To systematically review the effects of interventions designed to optimize prescribing in care homes.
- To identify effective strategies for improving medication management in elderly residents.
Main Methods:
- Searched MEDLINE, EMBASE, International Pharmaceutical Abstracts, and Cochrane Library from 1990.
- Included search terms: 'nursing home', 'residential home', 'inappropriate prescribing', 'education', and 'intervention'.
- Two independent reviewers screened studies and assessed methodological quality using the Downs and Black rating scale.
Main Results:
- 16 studies met inclusion criteria, identifying four intervention strategies: staff education, multi-disciplinary team (MDT) meetings, pharmacist medication reviews, and computerized clinical decision support systems (CDSSs).
- Complex educational programs, especially those focusing on behavioral management and drug prescribing, showed improvements in six of eight studies.
- Mixed results were observed for pharmacist interventions; one of two CDSS studies showed significant improvement, and two of three MDT studies indicated overall prescribing improvement.
Conclusions:
- No single intervention strategy has proven universally effective for optimizing prescribing in care homes.
- Educational interventions, including academic detailing, appear most promising.
- A multi-faceted approach incorporating clearer policy guidelines is likely necessary to enhance prescribing for vulnerable care home residents.
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