Doctors and pharmacists work together to reduce the use of medication at nursing homes

Reversing the trend of overprescription, which is a common problem in nursing homes, is a monumental challenge. Researchers from the University of Groningen and the University Medical Center Groningen have developed a promising method to help geriatric specialists in nursing homes reduce the use of medicines. This new strategy requires doctors and pharmacists to discuss and assess patients’ medication regimen together, and generated positive results during the testing phase of the project. The research will be published on 10 October 2017 in the leading medical journal Annals of Internal Medicine.

Nursing home residents are very vulnerable. They often suffer from several conditions at the same time and have to take a lot of different medication, some of which is simply unnecessary. Side effects of some medicines can lead to falls, hospitalisation, additional costs and even death. In order to reduce the amount of medication being administered at nursing homes, researchers from the Groningen Institute of Pharmacy, the University of Groningen and the General Practice and Geriatric Medicine departments at the UMCG developed and tested the Multidisciplinary Multistep Medication Review (3MR).

New situation

Patients who end up in nursing homes often have a complex medical history, and, as a result, have to take a lot of different medication. Specialists in geriatric medicine are faced with the difficult task of adjusting their medication to the new situation. Doctors who used the 3MR method were more successful at reducing medication levels than doctors in the control group; in the 3MR group, four out of ten patients were able to stop with one or more of their medications, whereas in the control group this was only three out of ten.

Review

In the 3MR method, the process of reviewing prescriptions is broken down into four steps. The doctor starts by assessing the patient’s status and situation, and then goes on to scrutinise the medication regimen. The doctor and pharmacist then jointly discuss and re-evaluate the medication which is currently being prescribed. Finally, the doctor makes changes to the medication and monitors the patient for any adverse side effects.

Four months

Over a four-month period, the research team, led by Katja Taxis, Professor of Pharmacotherapy and Clinical Pharmacy at the University of Groningen, followed nursing home residents with a life expectancy of more than four weeks at 59 departments and wards at nursing homes. Half of the residents were assigned doctors who used the 3MR guidelines to assess and adjust their medication. The other half, the control group, continued with their usual treatment.

Effective

The 3MR method proved effective in stopping unnecessary medication without resulting in a decline in the quality of life and general wellbeing of nursing home residents. The results of the research have shown that this is a very promising method which can be used to further reduce overprescription in nursing homes in the future.

More information

• 'Discontinuing inappropriate medication use in nursing home residents – A cluster randomized controlled trial' will be published in Annals of Internal Medicine on 10 October 2017
• For a copy of the article in PDF format, contact Cara Graeff: cgraeff@acponline.org
• Abstract: http://annals.org/aim/article/doi/10.7326/M16-2729
• Contact: Hans Wouters, senior researcher at the UMCG/University of Groningen and first author or Prof. Katja Taxis, Professor of Pharmacotherapy and Clinical Pharmacy at the University of Groningen and project leader.