Clinical and cost effectiveness of a multi-professional medication reviews in care homes (CAREMED)
Clinical and cost effectiveness of a multi-professional medication reviews in care homes (CAREMED)
OBJECTIVES: With 70% of care home residents experiencing a medication error every day in the UK, better multi-professional working between medical practitioners, pharmacists and care homes was recommended. The aim of this study was to determine the effectiveness (falls reduction) and cost-effectiveness, of a multi-professional medication review (MPMR) service in care homes for older people.
METHOD: A total of care homes in the East of England were cluster randomised to 'usual care' or two multi-professional (General practitioner, clinical pharmacist and care homes staff) medication reviews during the 12-month trial period. Target recruitment was 900 residents with 10% assumed loss to follow-up. Co-primary outcome measures were number of falls and potentially inappropriate prescribing assessed by the Screening Tool of Older Persons Prescriptions.
KEY FINDINGS: A total of 826 care home residents were recruited with 324 lost to follow-up for at least one primary outcome measure. The mean number of falls per resident per annum was 3.3 for intervention and 3.0 for control (P = 0.947). Each resident was found to be prescribed 0.69 (intervention) and 0.85 (control) potentially inappropriate medicines after 12 months (P = 0.046). No significant difference identified in emergency hospital admissions or deaths. Estimated unadjusted incremental mean cost per resident was £374.26 higher in the intervention group.
CONCLUSIONS: In line with other medication review based interventions in care homes, two MPMRs improved medication appropriateness but failed to demonstrate improvements in clinical outcomes. From a health system perspective costs where estimated to increase overall and therefore a different model of medicines management is required.
Accidental Falls/prevention & control, Aged, Aged, 80 and over, Cost-Benefit Analysis, England, Female, General Practitioners/organization & administration, Homes for the Aged, Hospitalization/statistics & numerical data, Humans, Inappropriate Prescribing/prevention & control, Male, Medication Errors/prevention & control, Medication Therapy Management/economics, Nursing Homes, Pharmacists/organization & administration
626-634
Desborough, James A
5ec7cf8c-01fe-40ab-ba59-2ffa7057be46
Clark, Allan
89b9f8d8-4b44-478e-86fe-245723d4df04
Houghton, Julie
0fa84e15-dd35-4c7e-b5df-3563629b2686
Sach, Tracey
5c09256f-ebed-4d14-853a-181f6c92d6f2
Shaw, Val
b8ed16c1-9087-4d00-9ab0-f0c3cf961a3d
Kirthisingha, Viveca
a2186556-d208-4ad1-91f2-5b3ad9b50c95
Holland, Richard C
910f8dc0-f653-4437-95f7-c0d513d88a80
Wright, David J
a55be721-4b15-4555-bf61-73fcb75c1a39
14 July 2020
Desborough, James A
5ec7cf8c-01fe-40ab-ba59-2ffa7057be46
Clark, Allan
89b9f8d8-4b44-478e-86fe-245723d4df04
Houghton, Julie
0fa84e15-dd35-4c7e-b5df-3563629b2686
Sach, Tracey
5c09256f-ebed-4d14-853a-181f6c92d6f2
Shaw, Val
b8ed16c1-9087-4d00-9ab0-f0c3cf961a3d
Kirthisingha, Viveca
a2186556-d208-4ad1-91f2-5b3ad9b50c95
Holland, Richard C
910f8dc0-f653-4437-95f7-c0d513d88a80
Wright, David J
a55be721-4b15-4555-bf61-73fcb75c1a39
Desborough, James A, Clark, Allan, Houghton, Julie, Sach, Tracey, Shaw, Val, Kirthisingha, Viveca, Holland, Richard C and Wright, David J
(2020)
Clinical and cost effectiveness of a multi-professional medication reviews in care homes (CAREMED).
International Journal of Pharmacy Practice, 28 (6), .
(doi:10.1111/ijpp.12656).
Abstract
OBJECTIVES: With 70% of care home residents experiencing a medication error every day in the UK, better multi-professional working between medical practitioners, pharmacists and care homes was recommended. The aim of this study was to determine the effectiveness (falls reduction) and cost-effectiveness, of a multi-professional medication review (MPMR) service in care homes for older people.
METHOD: A total of care homes in the East of England were cluster randomised to 'usual care' or two multi-professional (General practitioner, clinical pharmacist and care homes staff) medication reviews during the 12-month trial period. Target recruitment was 900 residents with 10% assumed loss to follow-up. Co-primary outcome measures were number of falls and potentially inappropriate prescribing assessed by the Screening Tool of Older Persons Prescriptions.
KEY FINDINGS: A total of 826 care home residents were recruited with 324 lost to follow-up for at least one primary outcome measure. The mean number of falls per resident per annum was 3.3 for intervention and 3.0 for control (P = 0.947). Each resident was found to be prescribed 0.69 (intervention) and 0.85 (control) potentially inappropriate medicines after 12 months (P = 0.046). No significant difference identified in emergency hospital admissions or deaths. Estimated unadjusted incremental mean cost per resident was £374.26 higher in the intervention group.
CONCLUSIONS: In line with other medication review based interventions in care homes, two MPMRs improved medication appropriateness but failed to demonstrate improvements in clinical outcomes. From a health system perspective costs where estimated to increase overall and therefore a different model of medicines management is required.
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Published date: 14 July 2020
Additional Information:
© 2020 The Authors. International Journal of Pharmacy Practice published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.
Keywords:
Accidental Falls/prevention & control, Aged, Aged, 80 and over, Cost-Benefit Analysis, England, Female, General Practitioners/organization & administration, Homes for the Aged, Hospitalization/statistics & numerical data, Humans, Inappropriate Prescribing/prevention & control, Male, Medication Errors/prevention & control, Medication Therapy Management/economics, Nursing Homes, Pharmacists/organization & administration
Identifiers
Local EPrints ID: 480878
URI: http://eprints.soton.ac.uk/id/eprint/480878
ISSN: 0961-7671
PURE UUID: 0397b98f-b7bc-4a02-89ca-93913355d10b
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Date deposited: 10 Aug 2023 16:40
Last modified: 17 Mar 2024 04:20
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Contributors
Author:
James A Desborough
Author:
Allan Clark
Author:
Julie Houghton
Author:
Tracey Sach
Author:
Val Shaw
Author:
Viveca Kirthisingha
Author:
Richard C Holland
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