Medication Therapy Management Guided by TIME Criteria in Nursing Home Residents: A Before-After Observational Study

Objectives: Inappropriate medication use is highly prevalent in nursing home residents and contributes to adverse drug events, falls, and increased healthcare utilization. The Turkish Inappropriate Medication use in oldEr adults (TIME) criteria provide a comprehensive framework for identifying both potentially inappropriate medications and prescribing omissions. We aimed to evaluate the outcomes of a Medication Therapy Management (MTM) intervention by use of TIME criteria among nursing home residents in Türkiye. Methods: This single-arm before-after observational study included 232 adults aged 60-110 years residing in the Bursa Metropolitan Municipality Nursing Home. Medication use patterns were evaluated using the TIME criteria and prescriptions were optimized through a Medication Therapy Management (MTM) intervention. Fall frequency and healthcare utilization outcomes were recorded during the 1 year before and after MTM implementation. Results: Following implementation of the Medication Therapy Management (MTM) approach based on TIME criteria, the median number of medications increased from 5 (IQR: 3-8) to 8 (IQR: 5-10) over one year (p < 0.001). During the post-implementation period, fall frequency, emergency department visits, family medicine visits, and non-geriatric specialist visits were lower compared with the pre-intervention year, whereas hospitalization rates did not significantly change. Conclusions: Among nursing home residents, the total number of medications was higher and fall frequency and selected healthcare utilization measures were lower during the year following implementation of MTM based on TIME criteria. These findings suggest that MTM-guided prescription optimization may be associated with changes in clinical and healthcare utilization outcomes; however, the absence of a control group precludes causal inference, and randomized controlled trials are required to confirm these associations.