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Age and Ageing Advance Access published online on September 22, 2004
Age and Ageing, doi:10.1093/ageing/afh213
© 2004 by British Geriatrics Society
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Received March 31, 2004
Accepted July 5, 2004

Article

An outreach geriatric medication advisory service in residential aged care: a randomized controlled trial of case conferencing

Maria Crotty 1*, Julie Halbert 1, Debra Rowett 1, Lynne Giles 1, Robert Birks 1, Helena Williams 2, and Craig Whitehead 1

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

* To whom correspondence should be addressed. E-mail: 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.
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