Implementation of medication reviews to optimize the use of medications in Swiss nursing homes: a mixed-methods study

Polypharmacy, can cause drug related problems (DRPs), including the use of potentially inappropriate medications (PIMs). Services such as medication reviews (MRs) have been initiated to address DRPs and PIMs, but their implementation remains underreported. In 2021 and 2022, a pilot project was developed with the goal of reorganizing the care of a pharmacy service to introduce a patient-centered, interprofessional MR service. The project, Medication Reviews in Nursing Homes (MRNH), took place in 10 Swiss nursing homes (NHs). The aim of this study was to evaluate the implementation and impact of the MRNH project in order to gain a better understanding of the processes involved in implementing MR in nursing homes.

This observational study followed a Type 3 hybrid implementation-effectiveness design using quantitative and qualitative analyses. Relevant implementation outcomes were defined through the Framework for the Implementation of Services in Pharmacy (FISpH) and the Reach, Effectiveness, Adoption, Implementation, Maintenance RE-AIM framework. Data were collected via questionnaires, focus groups and administrative records. The study evaluates factors and strategies related to the implementation of MRs and assesses the impact of MRs based on the proportion of resolved DRPs at a four-month follow-up.

The target was for each NH to perform MRs for 10% of the NHs population. Seven of the NHs achieved this goal, which results in 55 MRs presented of a theoretical total of 75. Following interprofessional team discussions, treatment plans including 145 modifications were created, of which 128 were effectively implemented. As 120 of them were maintained at follow-up, MRs performed lead to a 83% of a partial or complete resolution of the DRPs detected (CI: 74.5-90.7%; 43 MRs). Implementation strategies were considered as useful by HCPs, including pharmacist training, clinical support and audit & feedback and defining their own sub-process. Seven of 10 participating NHs continued MRs after MRNH.

The implementation of MRs in NHs was successful in seven of the 10 participating NHs. The service was considered feasible and accepted, and its dissemination was recommended by the participating healthcare professionals. The results of the study support the decision of the regional health department to extend the service to more NHs and may help identify strategies to further sustain its implementation.