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Therapeutic optimization through goal-oriented prescription in nursing homes
N Molist-Brunet1,2, D Sevilla-Sánchez3,4, J González-Bueno3,4
1Hospital Universitari de la Santa Creu de Vic, Vic, Barcelona, Spain. nmolist@gmail.com.
International Journal of Clinical Pharmacy
|November 28, 2020
Summary
Nursing home residents often experience frailty and polypharmacy. A patient-centred prescription (PCP) model identified inappropriate prescriptions (IP) in 92.2% of residents, highlighting the need for individualized care.
Area of Science:
- Gerontology
- Clinical Pharmacy
- Geriatric Medicine
Background:
- Nursing home residents are a vulnerable population with high rates of frailty and polypharmacy.
- Inappropriate prescribing is a common and significant issue in this demographic.
- Assessing frailty and medication appropriateness is crucial for improving resident care.
Purpose of the Study:
- To calculate the frailty index (FI) and assess the baseline situation of nursing home residents.
- To evaluate the effectiveness of a patient-centred prescription (PCP) model in pharmacotherapy review.
- To investigate the relationship between inappropriate prescriptions (IP) and frailty, functional dependence, dementia, and end-of-life status.
Main Methods:
- Prospective, descriptive, and observational study in two Spanish nursing homes.
- Application of the PCP model for pharmacotherapy review, focusing on global patient assessment and individual goals.
- Analysis of medication data to determine the prevalence of polypharmacy and IP.
Main Results:
- 103 frail, multimorbid residents were included, with 59.2% being totally dependent.
- The PCP model identified at least one inappropriate prescription (IP) in 92.2% of residents.
- Polypharmacy decreased from 72.55% to 52.94%, and excessive polypharmacy fell from 18.62% to 5.88% post-review.
Conclusions:
- Nursing home residents exhibit advanced frailty, necessitating tailored medical interventions.
- The PCP model is effective in identifying a high prevalence of inappropriate prescriptions (IP).
- Frailer, more dependent, and end-of-life residents are disproportionately affected by inappropriate medication.
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