Nurse and Pharmaceutical Care (NuPhaC)

OptiMEDs

OptiMEDs intervention for multidisciplinary medication review in nursing homes to evaluate the appropriateness of prescribing – a pilot study  

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Background 

The interest in improving the pharmacotherapy of older adults in nursing homes is growing. We propose a method intending to support the decision of GPs regarding the pharmacotherapy of older adults. To achieve this, we introduce the OptiMEDs intervention: a combination of an electronic decision support tool (for the appraisal of potentially inappropriate medication use, anticholinergic use, or medications that can be de-prescribed in view of limited life expectancy) with focussed nurse observations (guided by a list of potential medication symptoms based on the individual medication chart of the resident), that will serve as the basis for a multidisciplinary medication review with the input of the GP, community pharmacist and nurse. By using the OptiMEDs intervention, we expect to obtain a more appropriate, safer, and more cost-effective pharmacotherapy in nursing home residents (e.g. less medication-related symptoms, less potentially inappropriate prescribing, a better quality of life, less hospitalisations, health care usage, or mortality) 

 

Before investigating the effectiveness of the OptiMEDs intervention in a large pragmatic clinical trial comparing results of the intervention with standard of care, we will performing a pilot study in 3 nursing homes aiming to study the feasibility and acceptability of all components included in OptiMEDs. 

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Figure 1: Flowchart intervention

 

 

Summary of results 

A total of 148 participants, residing in 3 nursing homes, provided informed consent. Participants had a mean age of 87.2 years (range 67-101), with 75% being female and 51% suffering with dementia. The average number of medications varied between nursing homes (range 5.6 - 7.6). At least one ‘possible inappropriate medication’ was found in 93% of the participants. 

 

During observation by the nurse 83% of the residents in the intervention arm (N=100) had symptoms (range 1-19) potentially related to medications. 

 

Pharmacists gave advice to 44% of the residents and the GP (family doctor) changed at least one prescription in 34% of residents. There was a decrease of at least one medication in 36% of residents and at least one ‘possible inappropriate medication’ in 26% of residents in the intervention arm. 

 

Medication reviews supported by the OptiMEDs tool proved to be a user-friendly, and potentially time-saving method to involve all health-care professionals during a medication review. This pilot study supports the need for a larger trial of the wider implementation of the OptiMEDs tool in Belgian nursing homes in order to improve geriatric pharmacotherapeutic care in this frail population. 

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Figure 2: System Usability Scale results: How nurses evaluated the usability aspect of the OptiMEDs software 

 

Follow-up research: Expectations and conditions of primary care providers regarding the use of electronic tools in medication review 

Electronic tools that can support a medication review are on the rise. A widespread implementation of such tools in the Belgian context is still hindered by uncertainties about possible funding. This market research aimed to investigate the willingness of healthcare professionals to use and pay for these tools. 

Method A mixed-method research approach was employed. An anonymous quantitative survey was used to assess the preferences and willingness to pay of healthcare professionals (doctors, pharmacists, and nurses).  

Results 272 nurses, 107 doctors, and 88 pharmacists completed at least half of the survey. About 93% of all respondents saw potential in electronic tools as an added value to the quality of care. In terms of processes, communication with other healthcare providers and having an overview were the most desired functionalities. In terms of process support, assistance in medication selection (doctors) and listing of self-medication (nurses and pharmacists) were highlighted. Doctors (50%) and pharmacists (64%) indicated that they currently have insufficient time to perform medication reviews, and the majority would like to spend less time on it. Both doctors (60%) and pharmacists (65%) expressed a willingness to pay for an electronic tool, although a significant portion (45% of doctors, 35% of pharmacists) believed that investments and reimbursements should be covered by the government. 

Discussion There is willingness among doctors, pharmacists, and nurses to use and pay for electronic tools. Policymakers also emphasize the potential importance and potential health benefits, but they point out regional and federal obstacles that need to be clarified before implementation can become possible. 

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More information 

KCE website: https://kce.fgov.be/en/kce-trials/funded-trials/kce-17008-optimeds-intervention-for-multidisciplinary-medication-review-in-nursing-homes-to-evaluate  

Publication : https://linkinghub.elsevier.com/retrieve/pii/S0167494321000534