Efficacy, feasibility and acceptability of the OptiMEDs tool for multidisciplinary medication review in nursing homes.

Abstract

AIM(S)\nExploring efficacy, feasibility and acceptability of a complex multifaced intervention (OptiMEDs) supporting multidisciplinary medication reviews in Belgian nursing homes (NHs).\n\n\nMETHODS\nA pilot study in 2 intervention, 1 control NH was held, involving dementia and non-dementia NH residents (>65 years). OptiMEDs provided automated assessment of possible inappropriate medications (PIMs) and patient-specific nurse observation lists of potential side-effects. Medication changes were evaluated one month after the medication review. Feasibility and acceptability was collected via surveys among the health-care professionals. Trial registration NCT04142645, 31/10/2019.\n\n\nRESULTS\nParticipants (n\xa0=\xa0148, n\xa0=\xa0100 in the intervention NHs) had a mean age of 87.2 years, with 75.0% females and 49.3% non-dementia patients. Prevalence of PIM use was 84.7% and of potential medication side-effects 84.5%, (range 1-19 per resident). One month after the intervention, the medication use decreased in 35.8% and PIM use in 25.9% of surviving intervention NHresidents (n\xa0=\xa088). GPs changed more medications when side-effects were observed (42% when side-effects present versus 12% when no side-effects, p\xa0=\xa00.019). Median workload for nurses was 45\xa0min, 20 for pharmacists, and 8 for GPs. User satisfaction for the OptiMEDs tool was high (n\xa0=\xa033, median score of 8, IQR 6 -8), with GPs (n\xa0=\xa019) showing the highest appreciation. Nurses (n\xa0=\xa09) reported a median score on the System Usability Scale of 70 (IQR 55 - 72), with lower scores for learnability aspects.\n\n\nCONCLUSION\nThe OptiMEDs intervention was feasible and user-friendly, showing decreases in the medication and PIM use; without affecting patient safety. A cluster-randomized trial is needed to explore impact on patient-related outcomes.