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An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing
- 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.
- Subjects :
- Male
Aging
medicine.medical_specialty
Cost-Benefit Analysis
Pharmacist
Drug Costs
law.invention
Drug Utilization Review
Drug Therapy
Randomized controlled trial
law
Multidisciplinary approach
Intervention (counseling)
medicine
Cluster Analysis
Homes for the Aged
Humans
Aged
Aged, 80 and over
Patient Care Team
Geriatrics
business.industry
Health services research
General Medicine
Nursing Homes
Outreach
Family medicine
Regression Analysis
Female
Interdisciplinary Communication
Health Services Research
Geriatrics and Gerontology
business
Follow-Up Studies
Subjects
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