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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Article info
Publication history
Published online: November 19, 2020
Footnotes
We report grants from the Ministry of Health and Social Services of Quebec, the Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), the Canadian Consortium on Neurodegeneration in Aging (CCNA), the Fondation pour les aînés et l'Innovation Sociale (FAIS), and from the Baie St-Paul's hospital foundation, during the conduct of the study. Carolina Tisnado Garland received scholarship grants from Université Laval, the Centre d'excellence sur le vieillissement de Québec (CEVQ), and from the CERSSPL-UL. Caroline Sirois received a Junior 1 salary grant from the Fonds de Recherche du Québec - Santé (FRQS) and startup funds from CERSSPL-UL.
The authors declare no conflicts of interest.
Identification
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
