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Table 4 Description of included primary studies for the comparison medical review by pharmacist versus usual care

From: Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials

Study

Participants

Intervention

Comparison

Outcomes

Crotty

2004b [14]

Physicians, registered nurses, 56 residents in the intervention group and 54 residents in the control group that were assigned to 85 long term care facilities in Australia.

Mean age: 83 years.

Aimed at improving medication management services by transferring information on medications to care providers in the longterm care facilities. The transition pharmacist compiled a medication transfer summary and faxed this to the family physician and the community pharmacist. The pharmacist coordinated an evidence based medication review that was to be performed by the community pharmacist contracted to the facility within 14 days of the transfer. After this, the transition pharmacist also arranged and participated in a case conference with the family physician, the community pharmacist and a registered nurse at the facility within a month of the transfer.

Extent of implementation: Medical review was performed for 36 residents (64%). Case conferences took place for 8 residents (14%).

Usual care: Standard hospital discharge summary.

Medication Appropriateness Index score, falls, hospital admissions (emergency visits and readmissions).

Crotty

2004c [15]

General practitioners, geriatricians, pharmacists, residential care staff, 50 residents in 5 nursing homes in the intervention group and 50 residents in 5 nursing homes in control group 1 and 54 residents in control group 2 (not included here) in Australia.

Mean age: 85 years.

Aimed at improving appropriateness of medications. Two multidisciplinary case conferences (GP, geriatrician, pharmacist, residential care staff, representative of the Alzheimer's Association of South Australia) were conducted 6-12 weeks apart. A medical review was prepared beforehand by the resident's GP.

Extent of implementation: Not reported.

Usual care. Both groups received a half day education in how to handle behaviour problems in residents with dementia.

MAI (Medication Appropriateness Index) score, number of drugs.

Furniss

2000 [17]

158 residents in 7 nursing homes in the intervention group and 172 residents in 7 nursing homes in the control group in United Kingdom.

Mean age: 81 years.

Aimed at reducing the number of prescribed drugs. The pharmacist collected details of current medication for each resident from the Medicines Administration Record chart in each home, compiled a brief medical history and made the staff identify any current problems. The pharmacist checked whether the use of neuroleptics were in accordance with the US Ombudsman Reconciliation Act guidelines and made suggestions for change of medication if necessary. Three weeks afterwards, the homes were revisited to identify any immediate problems and to check on whether changes had been implemented.

Extent of implementation: Not reported.

Usual care.

Mean number of prescribed drugs.

Midlöv 2002 [23]

41 residents with epilepsy in the intervention group and 33 residents in the control group; 51 residents with Parkinson in the intervention group and 33 residents in the control group in 48 nursing homes in Sweden.

Mean age: 80 years.

Aimed at improving the pharmacological treatment. Pharmacists reviewed and documented the patients' drug use and any problems related to the drug use as reported by the residents, their contact person at the nursing home and the resident's physician. A multidisciplinary team consisting of the data collecting pharmacist, a pharmacist with a special experience in neurology, a primary care physician, neurologist, neuropsychiatrist and a clinical pharmacologist discussed the collected information and made suggestions. A list of recommended changes in medication was sent to the resident's physician.

Extent of implementation: Not reported.

Usual care.

Number of drugs.

Patterson 2010 [29]

11 nursing homes with 173 residents in intervention group and 11 nursing homes with 161 residents in control group.

Mean age: 83 years.

Aimed at reducing inappropriate prescription of psychoactive medications and falls. Specially trained study pharmacists visited nursing homes monthly for 12 months. Information for each resident was collected from the nursing home record, the GP and from the local community pharmacist if needed. The residents themselves, their nurses and next of kin were interviewed to assess residents' need for medication. An algorithm were used by pharmacists for guidance in assessing the inappropriateness of psychoactive medication. Recommendations were discussed with nursing staff. Meetings were held with the residents' GP to discuss and decide about medication and feedback were given to nursing staff.

Extent of implementation: Not reported.

Usual care.

Proportion of residents prescribed one or more inappropriate psychoactive (anxiolytic, hypnotic or antipsychotic) drugs, change in number of inappropriate psychoactive drugs, rate of falls per 100 resident months.

Schmidt

1998 [26]/Claesson

1998 [12]

626 residents in 15 nursing homes in the intervention group and 1128 residents in 18 nursing homes in the control group in Sweden.

Mean age: 83 years.

Aimed at minimising the use of nonrecommended drugs as defined by guidelines from the Swedish Medical Product Agency. One pharmacist was appointed from the local pharmacy to spend one day per month in a nursing home. The pharmacist attended two training sessions in geriatrics, drug use and in interdisciplinary collaboration methods before the intervention and three sessions during the 12 months intervention. The appointed pharmacists helped in organising monthly multidisciplinary meetings to discuss and improve the use of drugs that could cause confusion and memory impairment. A physician, pharmacist and selected nurses and nursing assistants participated in discussing each resident's drug use. The length of the meetings was locally adapted. Pharmacists formed regional networks to support their function in the project.

Extent of implementation: Not reported.

Usual care.

Number of prescriptions for any psychotropic, antipsychotics, hypnotics, anxiolytics, antidepressants.

Zermansky 2006 [28]

661 residents on one or more drugs selected from 65 nursing homes in United Kingdom: 331 allocated to the intervention group and 330 to the control group.

Mean age: 85 years.

Medical review by a pharmacist by using the patient's clinical record and by consultation with the patient and carer. On this basis, the pharmacist made recommendations and forwarded them on a written proforma to the GP for acceptance and implementation. The GPs indicated acceptance by ticking a box on the proforma.

Extent of implementation: Not reported.

Usual care.

Number of changes in medication per resident, total number of drugs used.