Pharmacy World and Science

, Volume 23, Issue 2, pp 41–45 | Cite as

Multidisciplinary case conference reviews: improving outcomes for nursing home residents, carers and health professionals

  • Michelle A. King
  • Michael S. Roberts


Aim of study: This study sought to determine whether multidisciplinary case conference reviews improved outcomes for nursing home residents, and the effects of this team approach to resident care on carers, including the hands-on carers employed by the nursing home, and health professionals.Method: 245 residents of three Canberra nursing homes were enrolled in this non-randomised controlled trial. The intervention consisted of sessions of three case conference reviews held between 10/4sol;96 and 4sol;12sol;96. These sessions were attended by the General Practitioners (GPs) of the residents discussed, the GP project officer from the ACT Division of General Practice, a clinical pharmacist, senior nursing staff, other health professionals eg physiotherapist, and occasionally the resident concerned or their representative. At each review, a case presentation by the resident's GP was followed by a multidisciplinary discussion of all aspects, medical and non-medical, of the resident's care. The review concluded with a management plan for the resident. In total 75 residents were reviewed.Main outcome measures: Medication use and cost, and mortality.Results: One month after the reviews were completed comparisons between those who were reviewed and those who were not showed non-significant reductions in medication orders, medication cost, and mortality in the reviewed group. Many of the 92 recommendations in the management plans that were carried out benefited the residents (n=37) and/or carers (n=24). The responses of the GPs and the Directors of Nursing to the reviews were overwhelmingly positive.Conclusion: Recommendations arising from multidisciplinary case conferences were carried out to the benefit of patients and carers. Given the support shown by key stakeholders, multidisciplinary conferences should be used more.

Aged Case conference Frail elderly Long‐term care Medication review Nursing homes Patient outcome Peer review, health care Pharmaceutical services Physicians, family 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Roberts MS, King M, Stokes JA, Lynne TA, Bonner CJ, McCarthy S, et al. Medication prescribing and administration in nursing homes. Age Ageing 1998;27:385-92Google Scholar
  2. 2.
    Nolan L, O'Malley K. Prescribing for the elderly part 1: sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc 1988;36:142-9Google Scholar
  3. 3.
    Kellaway GSM, McCrae E. Intensive monitoring for adverse drug effects in patients discharged from acute medical wards. NZ Med J 1973;7:525-8Google Scholar
  4. 4.
    Cadieux RJ. How multiple drug use increases risk exponentially. Postgrad Med 1989;86:179-86Google Scholar
  5. 5.
    Roberts MS, Stokes JA, King MA, Lynne TA, Bonner CJ, Purdie DM, et al. Outcomes of a randomised controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol (2001;51:259-68)Google Scholar
  6. 6.
    Departments of Medicine, Pharmacy, and Social and Preventive Medicine. Final report to the Commonwealth on the “Project to Optimise the Quality of Drug Use in the Elderly in Long Term Care Facilities in Australia”. University of Queensland, July 1995Google Scholar
  7. 7.
    Pharmaceutical Society of Australia. Comprehensive medication reviews in residential aged care facilities. Pharmacy Practice Handbook. Canberra: Pharmaceutical Society of Australia, March 1997Google Scholar
  8. 8.
    Quality of Medication Care Group. National evaluation of medication review services in Australian nursing homes. Final report to the Commonwealth. Quality of Medication Care Group on behalf of the Australian Association of Consultant Pharmacy, with funding from the Commonwealth Department of Health and Aged Care, 30 July 1999Google Scholar
  9. 9.
    Feldman EL. The interdisciplinary case conference. Acad Med 1999;74:594Google Scholar
  10. 10.
    Commonwealth Department of Health and Family Services. Schedule of Pharmaceutical Benefits. Canberra: Australian Government Publishing Service, 1 May 1997Google Scholar
  11. 11.
    Quality Medication Care. The provision of pharmaceutical review services for Veterans residing in nursing homes. Final Report Part 1. Quality Medication Care, April 1997 44 Pharmacy World & Science Volume 23 No. 2 2001Google Scholar
  12. 12.
    Owen PA, Allery LA, Harding KG, Hayes TM. General Practitioners' continuing medical education within and outside their practice. Br Med J 1989;299:238-40Google Scholar
  13. 13.
    Moran JA, Kirk P, Kopelow M. Measuring the effectiveness of a pilot continuing medical education program. Can Fam Physician 1996;42:272-6Google Scholar
  14. 14.
    Cantillon P, Jones R. Does continuing medical education in General Practice make a difference? Br Med J 1998;318:1276-9Google Scholar
  15. 15.
    Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance a systematic review of the effect of continuing medical education strategies. 1995;274:700-5Google Scholar
  16. 16.
    Zwar N, Wolk J, Gordon J, Sanson-Fisher R, Kehoe L. Influencing antibiotic prescribing in General Practice: a trial of prescriber feedback and management guidelines. Fam Pract 1999;16:495-500Google Scholar
  17. 17.
    Doyle C, Ward S. Education and training in residential dementia care in Australia: needs, provision and directions. Aust N Z J Public Health 1998;22:589-97Google Scholar
  18. 18.
    Commonwealth Department of Health and Aged Care. Medicare Benefits Schedule Book. Canberra: Australian Government Publishing Service, 1 Nov 2000 also at Scholar
  19. 19.
    Commonwealth of Australia, Pharmacy Guild of Australia. Third community pharmacy agreement between the Commonwealth of Australia and the Pharmacy Guild of Australia. Canberra: 2000 also at 45 Volume 23 No. 2 2001 Pharmacy World & Science Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Michelle A. King
    • 1
  • Michael S. Roberts
    • 1
  1. 1.Department of MedicineThe University of Queensland, Princess Alexandra HospitalWoolloongabbaAustralia

Personalised recommendations