(131) Pharmacological treatments and medication-related problems in nursing homes in Catalonia: The impact of a multidisciplinary team intervention

Background: Treating the elderly often entails polypharmacy to achieve optimal disease management, augmenting medication-related problems (MRPs). Routine pharmacological review is needed among institutionalized patients and may improve with a multidisciplinary intervention.

Objectives: To describe the MRPs detected after reviewing medication plans of the institutionalized patients and the recommendations given by a multidisciplinary team in nursing homes.

Methods: A multicenter before-after study, involving five nursing homes in Catalonia, assessed the impact of a multidisciplinary team intervention. The intervention spanned from July 2020 to February 2022. The inclusion criteria was institutionalized patients with public health coverage provided by the Health Department of Catalonia.
Intervention: The clinical pharmacologist was the medical doctor specialist who acted as the coordinator of the multidisciplinary team and actively reviewed all the prescribed medications to make recommendations and detect MRPs.
An estimation of the frequencies and percentages were made of clinical characteristics, diseases, pharmacological treatments, incomplete data, and frequencies of MRPs defined as 1) potential drug-drug interactions, 2) therapeutic duplications, 3) contraindications and 4) drugs deemed inappropriate or of doubtful efficacy. The description of the given recommendations was done, which were drugs recommended to withdraw, change or adequate.

Results: A total of 483 patients were included. Patients had a mean age of 86.3 (SD 8.8) years and 72.0% were female. All patients had at least 3 health-related problems, with a mean of 17.4 (SD 5.6). All patients, except one, had a minimum of one prescription, with a mean of 8.22 drugs prescribed (SD 3.5) per patient. Recommendations were made for 82.4% of the patients, of which 41.4% were followed. The intervention decreased prescribed medications (p=0.133), with 42.4% of recommended withdrawals enacted. The most frequent drugs recommended to withdraw were omeprazole 17%, acetylsalicylic acid 4.4% and alprazolam 3.5%, to change were simvastatin 8.9%, paroxetine 8.9% and pantoprazole 6.7%, and to adequate was quetiapine 10%, acetylsalicylic acid 6.1% and furosemide 5.3%.

Conclusions: The findings underscore the need for targeted interventions to reduce MRPs in nursing homes. Recommendations were mainly made on proton pump inhibitors, antithrombotics and anxiolytics/antidepressants, indicating a concerted effort to reduce MRPs. A multidisciplinary team approach, including general practitioners, geriatric assessment and a clinical pharmacologist should address this problem.