Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home

Núria Molist-Brunet, Daniel Sevilla-Sánchez, Emma Puigoriol-Juvanteny, Lorena Bajo-Peñas, Immaculada Cantizano-Baldo, Laia Cabanas-Collell and Joan Espaulella-Panicot
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Núria Molist-Brunet: Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain
Daniel Sevilla-Sánchez: Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic—University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
Emma Puigoriol-Juvanteny: Epidemiology Department, Hospital Universitari de Vic, 08500 Vic, Spain
Lorena Bajo-Peñas: Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain
Immaculada Cantizano-Baldo: Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain
Laia Cabanas-Collell: Institut Català de la Salut (ICS), 08551 Tona, Spain
Joan Espaulella-Panicot: Geriatric Department, Hospital Universitari de la Santa Creu de Vic, 08500 Vic, Spain

IJERPH, 2022, vol. 19, issue 6, 1-13

Abstract: (1) Background: aging is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. A periodic medication review (MR) in frail older people leads to optimizing medication use. The aims of the study were to perform a comparative analysis of the impact of place of residence (own home versus nursing home) in a cohort of older patients on the characteristics of the baseline therapeutic plan and characteristics of the therapeutic plan after an MR; (2) Methods: Study with paired pre- and post-MR data based on person-centred prescription, with a follow-up assessment at three months. Patients who lived either in their own home or in a nursing home were recruited. We selected patients of 65 years or more with multimorbidity whose General Practitioner identified difficulties with the prescription management and the need for an MR. Each patient’s treatment was analysed by applying the Patient-Centred Prescription (PCP) model; (3) Results: 428 patients. 90% presented at least one inappropriate prescription (IP) in both settings. In nursing homes, a higher number of implemented optimization proposals was detected (81.6% versus 65.7% ( p < 0.001)). After the MR, nursing-home patients had a greater decrease in their mean number of medications, polypharmacy prevalence, therapeutic complexity, and monthly drug expenditure ( p < 0.001); (4) Conclusions: PCP model detected a high number of IP in both settings. However, after an individualized MR, nursing-home patients presented a greater decrease in some pharmacological parameters related to adverse events, such as polypharmacy and therapeutic complexity, compared to those living at home. Nursing homes may be regarded as a highly suitable scenario to carry out a periodic MR, due to its high prevalence of frail people and its feasibility to apply the recommendations of an MR. Prospective studies with a robust design should be performed to demonstrate this quasi-experimental study along with a longitudinal follow-up on clinical outcomes.

Keywords: inappropriate prescription; nursing homes; polypharmacy (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (3)

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