Services in support of the OptiMEDs study.

Nursing homes residents often take many medications. Some medications can be potentially inappropriate, leading to side-effects such and increased risks for falls, hospitalisations or mortality. To reduce the number of potentially inappropriate medications, we present the OptiMEDs tool: a combined intervention of an electronic decision support tool for the identification of potentially inappropriate medications, anticholinergic medications, or medications that can be deprescribed, with focussed nurse-observations supporting a multidisciplinary medication review. The Ageing of the population will lead to more older adults. For Belgium; around 18% of the population is 65 years or older, but this number is to rise significantly to 23% by 2030 (equalling more than 100.000 extra adults of 65 years and older). These older adults will develop an increasing number of diseases (multimorbidity), affecting their social life, activities of daily living, and quality of life. As a result, they will be prescribed more medications, but this again can induce problems. Older adults are more sensitive to the effects and side-effects of medications than younger adults. DRPs potentially affect quality of life and are also an important risk factor for hospital admissions or increased risks for mortality. All prescribers face a more complex medication choice process in poly-medicated patients with a higher level of multimorbidity. All face the problem of lack of specific evidence in this particular age group so support complex drug choice processes with regard to efficacy and safety of medications. Medications can affect the quality of life of patients, could induce severe medication side-effects, and could increase the costs for the Belgian government. For Belgium, the findings of the PHEBE project indicate that nursing home residents have a high chronic intake of medications (mean of 7.1 chronic medications), costing up to 140€ each month. An analysis of the quality of prescribing showed that 82% of the nursing home residents had potentially inappropriate medications, showing the potential for optimising the pharmacotherapy. Currently, medication reviews are seldom performed, or are not structured. Nurses reported different barriers (a lack of pharmacotherapeutic knowledge, a lack of communication possibilities), believing that observation of Drug Related Problems (DRPs) is not part of their job. Pharmacists mostly restrict their role in nursing homes to the delivery of medications. With our intervention, we propose a method that could investigate the medication use on a deeper level, in order to support the decision of GPs regarding the pharmacotherapy of older adults. We want to aid and involve different actors (nurses and clinical pharmacists) in the medication review by offering them tools to strengthen their role (enhanced knowledge, focussed observation). The study objectives are to examine whetherThe OptiMEDs intervention, the combination of an electronic decision support tool (for the appraisal of potentially inappropriate medication use, anticholinergic use, or medications that can be deprescribed in the medication chart of nursing home residents) with focussed nurse observations (derived from the Pharmanurse component in the OptiMEDs software, where potential medication symptoms are listed based on the medication chart of nursing home residents), that will serve as the basis during a medication review between GPs and nurses (where additional feedback from clinical pharmacists is provided) can lead to a more appropriate, safer, and more cost-effective pharmacotherapy in nursing home residents (e.g. less medication-related symptoms, less inappropriate prescribing, a better quality of life, less hospitalisations, health care usage, or mortality).

Keywords:PHARMACOTHERAPY, PHARMACEUTICAL CARE, NURSING, GERIATRICS

Disciplines:Nursing not elsewhere classified, Pharmaceutical care, Pharmacotherapy

Project type:Service project