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Effect of an ongoing pharmacist service to reduce medicine-induced deterioration and adverse reactions in aged-care facilities (nursing homes): a multicentre, randomised controlled trial (the ReMInDAR trial)

Citation

Roughead, EE and Pratt, NL and Parfitt, G and Rowett, D and Kalisch-Ellett, LM and Bereznicki, L and Merlin, T and Corlis, M and Kang, AC and Whitehouse, J and Bilton, R and Schubert, C and Torode, S and Kelly, T-L and Andrade, AQ and Post, D and Dorj, G and Cousins, J and Williams, M and Lim, R, Effect of an ongoing pharmacist service to reduce medicine-induced deterioration and adverse reactions in aged-care facilities (nursing homes): a multicentre, randomised controlled trial (the ReMInDAR trial), Age and Ageing, 51, (4) Article afac092. ISSN 0002-0729 (2022) [Refereed Article]


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DOI: doi:10.1093/ageing/afac092

Abstract

Objective: To assess the effectiveness of a pharmacist-led intervention using validated tools to reduce medicine-induced deterioration and adverse reactions.

Design and setting: Multicenter, open-label parallel randomised controlled trial involving 39 Australian aged-care facilities.

Participants: Residents on ≥4 medicines or ≥1 anticholinergic or sedative medicine.

Intervention: Pharmacist-led intervention using validated tools to detect signs and symptoms of medicine-induced deterioration which occurred every 8 weeks over 12 months.

Comparator: Usual care (Residential Medication Management Review) provided by accredited pharmacists.

Outcomes: Primary outcome was change in Frailty Index at 12 months. Secondary outcomes included changes in cognition, 24-hour movement behaviour by accelerometry, grip strength, weight, adverse events and quality of life.

Results: 248 persons (median age 87 years) completed the study; 120 in the interventionand, 128 in control arms. In total 575 pharmacist, sessions were undertaken in the intervention arm. There was no statistically significant difference for change in frailty between groups (mean difference: 0.009, 95% CI: -0.028, 0.009, P = 0.320). A significant difference for cognition was observed, with a mean difference of 1.36 point change at 12 months (95% CI: 0.01, 2.72, P = 0.048). Changes in 24-hour movement behaviour, grip strength, adverse events and quality of life were not significantly different between groups. Point estimates favoured the intervention arm at 12 months for frailty, 24-hour movement behaviour and grip strength.

Conclusions: The use of validated tools by pharmacists to detect signs of medicine-induced deterioration is a model of practice that requires further research, with promising results from this trial, particularly with regards to improved cognition.

Item Details

Item Type:Refereed Article
Keywords:activity tracker, cognitive function, physical activity, medication safety, health services research, older people
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacy and pharmacy practice
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health and support services not elsewhere classified
UTAS Author:Bereznicki, L (Professor Luke Bereznicki)
UTAS Author:Cousins, J (Mr Justin Cousins)
UTAS Author:Williams, M (Dr Mackenzie Williams)
ID Code:151138
Year Published:2022
Web of Science® Times Cited:1
Deposited By:Pharmacy
Deposited On:2022-07-20
Last Modified:2022-09-20
Downloads:0

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