Effects of an interprofessional Quality Circle-Deprescribing Module (QC-DeMo) in Swiss nursing homes: a randomised controlled trial

BMC Geriatrics

Pierluigi Ballabeni¹  Anne Niquille²  Damien Cateau² 

[1] Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland;Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland;School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland;Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland;

关键词: Deprescribing;    Nursing home;    Quality circle;    Collaboration;    Potentially inappropriate medications;   

DOI  :  10.1186/s12877-021-02220-y

来源: Springer

【 摘 要 】

BackgroundPotentially inappropriate medications (PIMs) are common among nursing homes (NH) residents, as is polypharmacy. Deprescribing has emerged in the past decade as a safe and effective way to reduce the use of PIMs and improve patient outcomes. However, effective deprescribing interventions are expensive, as they require specialised staff and a great amount of time for each resident.The Quality Circle Deprescribing Module (QC-DeMo) intervention was designed to be less resource-intensive than medication reviews, the current deprescribing gold standard. It consists of a QC session in which physicians, nurses, and pharmacists define a local deprescribing consensus for specific PIMs classes, which is then implemented in the NH. The intervention was trialled in a RCT, with the NH as unit of analysis.MethodsAfter randomisation, intervention NHs enacted the QC-DeMo at the start of the follow-up year. The primary outcomes were the proportion of PIM galenic units and number of PIM defined daily dose per average resident and per day (DDD/res). PIM status was assessed by a combination of the 2015 Beers list and the Norwegian General Practice-Nursing Home criteria. Secondary outcomes were the number of DDD/res to avoid and to reevaluate; safety outcomes were mortality, hospitalisations, falls, and use of physical restraints. Outcomes were evaluated at follow-up using linear regression models, adjusting for the outcome baseline values.ResultsFifty-eight NHs took part in the trial; no individual residents were recruited. The intervention did not reduce the primary outcomes, but a strong trend towards reduction was seen for the number of PIM DDD/res, which accounts for the doses used. PIM DDD/res to reevaluate were significantly reduced, mostly through a reduction in the use of proton-pump inhibitors. Falls and use of physical restraints were not affected, but a statistical interaction between the mission of the NH (geriatric unit or specialised dementia unit) and the intervention group was seen for mortality and hospitalisations.ConclusionsThe QC-DeMo intervention can reduce the use of some PIM classes, and could usefully complement other deprescribing interventions.Trial registrationClinicalTrials.gov (NCT03688542), registered on 26.09.2018, retrospectively registered.

【 授权许可】

CC BY