Artikel
Connecting the dots: impact of interprofessional medication reviews supported by health information technology (HIT) on medication appropriateness
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Veröffentlicht: | 25. September 2020 |
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Background and current (inter)national research: Polypharmacy and inappropriate use of medication is a widespread issue in nursing home residents (NHRs) [1]. Managing medication in NHRs is an interprofessional challenge, which can be exacerbated by gaps in transfer of medication-related information [2]. Health information technology (HIT) has been proposed as a way to bridge these gaps [1], [2].
Research question and objective: An intervention tailored to routine care processes combining educational training, HIT and a therapy check-process to improve cooperation between healthcare professionals was developed. We tested its impact on the appropriateness of medication prescribed to NHRs.
Methods or hypothesis: A non-randomized controlled study was conducted in six nursing homes (NHs) (2016-2018). We assessed medication appropriateness using the Medication Appropriateness Index (MAI), as well as several potential risk factors of inappropriate medication [3]. Data was collected before (t0), during (t1, month 12) and after (t2, month 18) intervention. Descriptive analysis as well as multivariable linear regression were performed. Subgroup analysis was done to examine interventional impact if medication is inappropriate at baseline.
Results: 6 NHs, 17 GPs and 240 NHRs (68.8% female; mean age 85.0) were included. Mean MAI-change was -3.4 (intervention group (IG)) vs. -1.5 (control group (CG)). Cut-off for subgroup analysis was identified as baseline MAI ≥23. In this group, MAI-change was -10.3 (IG) vs. -3.5 (CG). In multivariable regression models, intervention was a significant predictor of improvement in MAI. In the IG, NHRs in the subgroup ≥23 MAI points were significantly younger, with higher cognitive ability and a higher number of medications prescribed than those below cut-off.
Discussion: Mean reduction in IG compared to CG in the whole sample was smaller than hypothesized. Mean improvement observed in CG might be attributed to changes made during routine care. Subgroup analysis showed larger improvement in the IG compared to the CG.
Implications for practice: A tailored HIT intervention was shown to be a feasible approach to improve NHRs’ medication appropriateness. Impact of the intervention was larger in NHRs with comparatively inappropriate medication at baseline.
References
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