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An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing

Authors :
Craig Whitehead
Debra Rowett
Lynne C. Giles
Maria Crotty
Robert Birks
Julie Halbert
Helena Williams
Source :
Age and Ageing. 33:612-617
Publication Year :
2004
Publisher :
Oxford University Press (OUP), 2004.

Abstract

Background: efficient strategies are needed to provide specialist advice in nursing homes to ensure quality medical care. We describe a case conference intervention involving a multidisciplinary team of health professionals. Objectives: to evaluate the impact of multidisciplinary case conferences on the appropriateness of medications and on patient behaviours in high-level residential aged care facilities. Design: cluster-randomised controlled trial. Setting: ten high-level aged care facilities. Participants: 154 residents with medication problems and/or challenging behaviours were selected for case conference by residential care staff. Intervention: two multidisciplinary case conferences involving the resident’s general practitioner, a geriatrician, a pharmacist and residential care staff were held at the nursing home for each resident. Measurements: outcomes were assessed at baseline and 3 months. The primary outcome was the Medication Appropriateness Index (MAI). The behaviour of each resident was assessed via the Nursing Home Behaviour Problem Scale. Results: 45 residents died before follow-up. Medication appropriateness improved in the intervention group [MAI mean change 4.1, 95% confidence interval (CI) 2.1–6.1] compared with the control group (MAI mean change 0.4, 95% CI −0.4−1.2; P < 0.001). There was a significant reduction in the MAI for benzodiazepines (mean change control −0.38, 95% CI −1.02−0.27 versus intervention 0.73, 95% CI 0.16–1.30; P = 0.017). Resident behaviours were unchanged after the intervention and the improved medication appropriateness did not extend to other residents in the facility. Conclusion: multidisciplinary case conferences in nursing homes can improve care. Outreach specialist services can be delivered without direct patient contact and achieve improvements in prescribing.

Details

ISSN :
14682834 and 00020729
Volume :
33
Database :
OpenAIRE
Journal :
Age and Ageing
Accession number :
edsair.doi.dedup.....13770f2aa01f36aa577e6d01e4909af3
Full Text :
https://doi.org/10.1093/ageing/afh213