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A New Care Model Reduces Polypharmacy and Potentially Inappropriate Medications in Long-Term Care

  • Carolina Tisnado Garland
    Affiliations
    Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada

    Centre d'excellence sur le vieillissement de Québec (CEVQ), CIUSSS of the Capitale-Nationale, Quebec City, Quebec, Canada
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  • Line Guénette
    Affiliations
    Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada

    CHU de Québec Research Centre, Population Health and Optimal Health Practices Research Unit, Quebec City, Quebec, Canada
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  • Edeltraut Kröger
    Affiliations
    Centre d'excellence sur le vieillissement de Québec (CEVQ), CIUSSS of the Capitale-Nationale, Quebec City, Quebec, Canada

    Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
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  • Pierre-Hugues Carmichael
    Affiliations
    Centre d'excellence sur le vieillissement de Québec (CEVQ), CIUSSS of the Capitale-Nationale, Quebec City, Quebec, Canada
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  • Rachel Rouleau
    Affiliations
    Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Quebec City, Quebec, Canada

    Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec City, Quebec, Canada
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  • Caroline Sirois
    Correspondence
    Address correspondence to Caroline Sirois, PhD, CEVQ, 1050 Chemin Ste-Foy, Quebec City, Quebec, G1S 4L8, Canada.
    Affiliations
    Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada

    Centre d'excellence sur le vieillissement de Québec (CEVQ), CIUSSS of the Capitale-Nationale, Quebec City, Quebec, Canada
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Published:November 19, 2020DOI:https://doi.org/10.1016/j.jamda.2020.09.039

      Abstract

      Objectives

      Assess the impact of a new pharmaceutical care model on (1) polypharmacy and (2) potentially inappropriate medication (PIM) use in long-term care facilities (LTCFs).

      Design

      Pragmatic quasi-experimental study with a control group. This multifaceted model enables pharmacists and nurses to increase their professional autonomy by enforcing laws designed to expand their scope of practice. It also involves a strategic reorganization of care, interdisciplinary training, and systematic medication reviews.

      Setting and Participants

      Two LTCFs exposed to the model (409 residents) were compared to 2 control LTCFs (282 residents) in Quebec, Canada. All individuals were aged 65 years or older and residing in included LTCFs.

      Measures

      Polypharmacy (≥10 medications) and PIM (2015 Beers criteria) were analyzed throughout 12 months between March 2017 and June 2018. Groups were compared before and after implementation using repeated measures mixed Poisson or logistic regression models, adjusting for potential confounding variables.

      Results

      Over 12 months, for regular medications, polypharmacy decreased from 42% to 20% (exposed group) and from 50% to 41% (control group) [difference in differences (DID): 13%, P < .001]. Mean number of PIMs also decreased from 0.79 to 0.56 (exposed group) and from 1.08 to 0.90 (control group) (DID: 0.05, P = .002).

      Conclusions and Implications

      Compared with usual care, this multifaceted model reduced the probability of receiving ≥10 medications and the mean number of PIMs. Greater professional autonomy, reorganization of care, training, and medication review can optimize pharmaceutical care. As the role of pharmacists is expanding in many countries, this model shows what could be achieved with increased professional autonomy of pharmacists and nurses in LTCFs.

      Keywords

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