Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial

Janet K Sluggett; Esa Y H Chen; Jenni Ilomäki; Megan Corlis; Jan Van Emden; Michelle Hogan; Tessa Caporale; Claire Keen; Ria Hopkins; Choon Ean Ooi; Sarah N Hilmer; Georgina A Hughes; Andrew Luu; Kim-Huong Nguyen; Tracy Comans; Susan Edwards; Lyntara Quirke; Allan Patching; J Simon Bell

doi:10.1016/j.jamda.2020.02.003

Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial

J Am Med Dir Assoc. 2020 Aug;21(8):1114-1120.e4. doi: 10.1016/j.jamda.2020.02.003. Epub 2020 Mar 13.

Authors

Janet K Sluggett¹, Esa Y H Chen², Jenni Ilomäki³, Megan Corlis⁴, Jan Van Emden⁴, Michelle Hogan⁴, Tessa Caporale⁵, Claire Keen⁶, Ria Hopkins⁶, Choon Ean Ooi², Sarah N Hilmer⁷, Georgina A Hughes⁶, Andrew Luu⁶, Kim-Huong Nguyen⁸, Tracy Comans⁸, Susan Edwards⁹, Lyntara Quirke¹⁰, Allan Patching¹¹, J Simon Bell¹²

Affiliations

¹ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia. Electronic address: janet.sluggett@monash.edu.
² Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
³ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia.
⁵ Helping Hand Aged Care, North Adelaide, South Australia, Australia.
⁶ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
⁷ NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
⁸ NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Centre for Health Services Research, The University of Queensland, Woolloogabba, Queensland, Australia.
⁹ Drug & Therapeutics Information Service, GP Plus Marion, South Australia, Australia.
¹⁰ Consumer Representative, Dementia Australia, Scullin, Australian Capital Territory, Australia.
¹¹ Helping Hand Consumer and Carer Reference Group, Helping Hand Aged Care, North Adelaide, South Australia, Australia.
¹² Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

PMID: 32179001
DOI: 10.1016/j.jamda.2020.02.003

Abstract

Objective: To assess the application of a structured process to consolidate the number of medication administration times for residents of aged care facilities.

Design: A nonblinded, matched-pair, cluster randomized controlled trial.

Setting and participants: Permanent residents who were English-speaking and taking at least 1 regular medication, recruited from 8 South Australian residential aged care facilities (RACFs).

Methods: The intervention involved a clinical pharmacist applying a validated 5-step tool to identify opportunities to reduce medication complexity (eg, by administering medications at the same time or through use of longer-acting or combination formulations). Residents in the comparison group received routine care. The primary outcome at 4-month follow-up was the number of administration times per day for medications charted regularly. Resident satisfaction and quality of life were secondary outcomes. Harms included falls, medication incidents, hospitalizations, and mortality. The association between the intervention and primary outcome was estimated using linear mixed models.

Results: Overall, 99 residents participated in the intervention arm and 143 in the comparison arm. At baseline, the mean resident age was 86 years, 74% were female, and medications were taken an average of 4 times daily. Medication simplification was possible for 62 (65%) residents in the intervention arm, with 57 (62%) of 92 simplification recommendations implemented at follow-up. The mean number of administration times at follow-up was reduced in the intervention arm in comparison to usual care (-0.36, 95% confidence interval -0.63 to -0.09, P = .01). No significant changes in secondary outcomes or harms were observed.

Conclusions and implications: One-off application of a structured tool to reduce regimen complexity is a low-risk intervention to reduce the burden of medication administration in RACFs and may enable staff to shift time to other resident care activities.

Keywords: Cluster randomized controlled trial; long-term care; medication administration; medication regimen simplification; nursing homes; residential aged care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Assisted Living Facilities*
Australia
Female
Humans
Long-Term Care*
Male
Pharmacists
Quality of Life