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Related Experiment Video

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Brain Morphology of Cannabis Users With or Without Psychosis: A Pilot MRI Study
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A pilot study of a Medication Rationalization (MERA) intervention.

Rachel Whitty1, Sandra Porter1, Kiran Battu1

  • 1Affiliations: Departments of Pharmacy (Whitty, Porter, Battu, Bhatt) and Medicine (Koo, R. Wu, P.E. Wu, Bogach, Downar) and Centre for Innovation in Complex Care (Delicaet), University Health Network; Centre for Addiction and Mental Health (Kalocsai), Toronto, Ont.

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Summary

The Medication Rationalization (MERA) approach effectively reduced inappropriate medications in frail inpatients. This interprofessional intervention improved medication use and was well-received by patients and medical teams.

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Area of Science:

  • Geriatric Medicine
  • Clinical Pharmacy
  • Internal Medicine

Background:

  • Seriously ill and frail inpatients often receive inappropriate medications.
  • These patients may not receive necessary medications for advanced illness symptoms.
  • An interprofessional Medication Rationalization (MERA) approach was developed to address these issues.

Purpose of the Study:

  • To pilot the Medication Rationalization (MERA) approach in seriously ill and frail inpatients.
  • To assess the feasibility, acceptability, efficiency, and effectiveness of MERA.
  • To deprescribe inappropriate medications and prescribe appropriate comfort medications.

Main Methods:

  • A single-centre pilot study was conducted on inpatients at risk of 6-month mortality.
  • An interprofessional MERA team reviewed patient medications and made guideline-based recommendations.
  • Feasibility, acceptability, efficiency, and effectiveness were measured endpoints.

Main Results:

  • 61 of 115 eligible patients (53%) were enrolled, with a mean age of 79.6 years.
  • The MERA team recommended 263 medication changes, with 85% accepted.
  • Patients receiving MERA stopped significantly more inappropriate medications (3.1 vs. 0.9 per patient, p < 0.01).

Conclusions:

  • The MERA intervention is feasible, acceptable, efficient, and potentially effective for medication changes in frail elderly inpatients.
  • Automation and integration with medication reconciliation could enhance scalability and effectiveness.
  • MERA shows promise for optimizing medication use in vulnerable patient populations.