Age and Ageing Advance Access originally published online on September 22, 2004
Age and Ageing 2004 33(6):612-617; doi:10.1093/ageing/afh213
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Age and Ageing Vol. 33 No. 6 © British Geriatrics Society 2004; all rights reserved
Research Paper |
An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing
1 Flinders University Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia 5041, Australia
2 Adelaide Southern Division of General Practice, 2a Jetty Road, Brighton, South Australia 5048, Australia
Address correspondence to: M. Crotty, Flinders University Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia 5041, Australia. Fax (+618) 8275 1130. Email: Maria.Crotty{at}flinders.edu.au
Abstract
Background: efficient strategies are needed to provide specialist advice in nursing homes to ensure quality medical care. We describe a case conference intervention involving a multidisciplinary team of health professionals.
Objectives: to evaluate the impact of multidisciplinary case conferences on the appropriateness of medications and on patient behaviours in high-level residential aged care facilities.
Design: cluster-randomised controlled trial.
Setting: ten high-level aged care facilities.
Participants: 154 residents with medication problems and/or challenging behaviours were selected for case conference by residential care staff.
Intervention: two multidisciplinary case conferences involving the resident's general practitioner, a geriatrician, a pharmacist and residential care staff were held at the nursing home for each resident.
Measurements: outcomes were assessed at baseline and 3 months. The primary outcome was the Medication Appropriateness Index (MAI). The behaviour of each resident was assessed via the Nursing Home Behaviour Problem Scale.
Results: 45 residents died before follow-up. Medication appropriateness improved in the intervention group [MAI mean change 4.1, 95% confidence interval (CI) 2.1–6.1] compared with the control group (MAI mean change 0.4, 95% CI –0.4–1.2; P < 0.001). There was a significant reduction in the MAI for benzodiazepines (mean change control –0.38, 95% CI –1.02–0.27 versus intervention 0.73, 95% CI 0.16–1.30; P = 0.017). Resident behaviours were unchanged after the intervention and the improved medication appropriateness did not extend to other residents in the facility.
Conclusion: multidisciplinary case conferences in nursing homes can improve care. Outreach specialist services can be delivered without direct patient contact and achieve improvements in prescribing.
Keywords: case conferencing, residential care, behavioural symptoms, medication, randomised controlled trial, elderly
Received March 31, 2004; Revision received July 5, 2004. accepted in revised form July 5, 2004.
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