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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet].

Interventions to optimise prescribing for older people in care homes

This version published: 2013; Review content assessed as up-to-date: October 11, 2012.

Plain language summary

Older people living in care homes (also called nursing homes, residential homes, skilled‐nursing facilities, assisted‐living facilities or aged‐care facilities) have many complex physical and mental health problems. Care home residents are prescribed many medicines compared to people who live in their own homes, with an average of eight medicines being common. International research has shown that these medicines are often not well managed, with some residents prescribed medicines inappropriately. This has the potential to lead to harmful side effects and a loss of benefit. For these reasons, it is important to make sure that care home residents are prescribed the right medicines at the right doses.

This review found eight studies involving 7653 residents in 262 care homes in six countries that evaluated interventions to optimise prescribing for care home residents. Most of the interventions had several components, often involving a review of medicines with a pharmacist and doctor. Some interventions included a teaching component and one study used Information Technology.

There was no evidence of benefit of the interventions with respect to reducing adverse drug events (harmful effects caused by medicines), hospital admissions or death. None of the studies looked at quality of life. Problems relating to medicines were found and addressed through the interventions used in the studies. Prescribing was improved based on criteria used to assess the appropriateness of prescribing in two studies.

More high‐quality studies need to be done to gather more evidence for these and other types of interventions. Further studies are needed to evaluate new technologies, including computer systems that support prescribing decisions.  More work needs to be done to make sure that researchers are consistently measuring outcomes that are important to care home residents.

Abstract

Background: There is a substantial body of evidence that prescribing for care home residents is suboptimal and requires improvement. Consequently, there is a need to identify effective interventions to optimise prescribing and resident outcomes in this context.

Objectives: The objective of the review was to determine the effect of interventions to optimise prescribing for older people living in care homes.

Search methods: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library (Issue 11, 2012); Cochrane Database of Systematic Reviews, The Cochrane Library (Issue 11, 2012); MEDLINE OvidSP (1980 on); EMBASE, OvidSP (1980 on); Ageline, EBSCO (1966 on); CINAHL, EBSCO (1980 on); International Pharmaceutical Abstracts, OvidSP (1980 on); PsycINFO, OvidSP (1980 on); conference proceedings in Web of Science, Conference Proceedings Citation Index ‐ SSH & Science, ISI Web of Knowledge (1990 on); grey literature sources and trial registries; and contacted authors of relevant studies. We also reviewed the references lists of included studies and related reviews (search period November 2012).

Selection criteria: We included randomised controlled trials evaluating interventions aimed at optimising prescribing for older people (aged 65 years or older) living in institutionalised care facilities. Studies were included if they measured one or more of the following primary outcomes, adverse drug events; hospital admissions;mortality; or secondary outcomes, quality of life (using validated instrument); medication‐related problems; medication appropriateness (using validated instrument); medicine costs.

Data collection and analysis: Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. A narrative summary of results was presented.

Main results: The eight included studies involved 7653 residents in 262 (range 1 to 85) care homes in six countries. Six studies were cluster‐randomised controlled trials and two studies were patient‐randomised controlled trials. The interventions evaluated were diverse and often multifaceted. Medication review was a component of seven studies, three studies involved multidisciplinary case‐conferencing, two studies involved an educational element for care home staff and one study evaluated the use of clinical decision support technology. Due to heterogeneity, results were not combined in a meta‐analysis. There was no evidence of an effect of the interventions on any of the primary outcomes of the review (adverse drug events, hospital admissions and mortality). No studies measured quality of life. There was evidence that the interventions led to the identification and resolution of medication‐related problems. There was evidence from two studies that medication appropriateness was improved. The evidence for an effect on medicine costs was equivocal.

Authors' conclusions: Robust conclusions could not be drawn from the evidence due to variability in design, interventions, outcomes and results. The interventions implemented in the studies in this review led to the identification and resolution of medication‐related problems, however evidence of an effect on resident‐related outcomes was not found. There is a need for high‐quality cluster‐randomised controlled trials testing clinical decision support systems and multidisciplinary interventions that measure well‐defined, important resident‐related outcomes.

Editorial Group: Cochrane Effective Practice and Organisation of Care Group.

Publication status: New.

Citation: Alldred DP, Raynor DK, Hughes C, Barber N, Chen TF, Spoor P. Interventions to optimise prescribing for older people in care homes. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD009095. DOI: 10.1002/14651858.CD009095.pub2. Link to Cochrane Library. [PubMed: 23450597]

Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PMID: 23450597

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