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A Multicomponent Intervention to Optimize Psychotropic Drug Prescription in Elderly Nursing Home Residents: An Italian Multicenter, Prospective, Pilot Study

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Abstract

Background

Older nursing home residents often have a large number of diseases and frequently require multiple medications; the high consumption of psychotropic drugs is of particular concern. The majority of residents in nursing homes suffer from dementia, and the use of psychotropic drugs in these patients is very high. Prescription for short periods of time only are usually recommended to avoid the risk of adverse drug reactions and potentially severe drug–drug interactions (DDIs).

Objectives

The aim of this multicenter, prospective study was to optimize the prescription of psychotropic drugs, according to the Beers recommendations, in a sample of older patients living in nursing homes in Italy, through a multicomponent intervention, education of general practitioners, and the use of INTERcheck.

Methods

The study was run in ten nursing homes in Northern Italy from September 2013 to May 2014 (9 months), with the voluntary participation of 14 general practitioners. Each physician was asked to enroll at least 20 consecutive unselected patients. Three educational interventions (‘ex cathedra’ presentations) were organized by the researchers involved in the project, and a fourth training session was also held on the use of INTERCheck, a Computerized Prescription Support System (CPSS) developed to optimize drug prescription for older people with multimorbidity. Drug prescription information and sociodemographic characteristics of each patient were collected at three different time points—before the educational and training sessions (T0), after 5 months (T1), and after 9 months (T2).

Results

Among the 272 patients included in the analysis, a significant reduction was observed in the mean number of drugs, and in the percentage receiving psychotropic drugs and potentially inappropriate psychotropic drugs (11.5 and 30.6 %, respectively; p < 0.0001). Patients exposed to at least one potentially severe DDI also decreased from 145 (53.3 %) at the first time point to 87 (32.0 %) at the last time point (p < 0.0001). Results were confirmed in the 181 patients for whom information regarding drug treatment was available at all time points.

Conclusions

The combination of an educational intervention and the CPSS can achieve a significant reduction in potentially inappropriate psychotropic drug use, psychotropic duplicates, and potentially severe DDIs in nursing homes.

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Acknowledgments

The authors are grateful to J. D. Baggott for editorial assistance, and to the general practitioners who voluntarily participated in the study: Ana Alvarez, Angelo Forti in collaboration with Myriam Cesaretti, Anna Maria Scotuzzi, Antonio Cartisano, Barbara Ottobri, Emilia Verzeletti, Emma Canossi, Ferdinando Sozzi, Grazia Ventisette, Lorenzo Archetti, Luigi Valenti, Matilde Ferrari, Mauro Zimelli, and Paolo Tanghetti.

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Authors and Affiliations

  1. Pharmacotherapy and Appropriateness of Drugs Prescription Unit, IRCCS-Istituto di Ricerche farmacologiche “Mario Negri”, Via Giuseppe La Masa, 19, 20156, Milan, Italy

    Luca Pasina, Flavio Suardi, Codjo D. Djade, Alessandro Nobili & Carlotta Franchi

  2. Geriatric Unit, Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Alessandra Marengoni & Simona Ghibelli

  3. Brescia Solidale Foundation Nursing Homes, Brescia, Italy

    Gianbattista Guerrini

Authors
  1. Luca Pasina
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  2. Alessandra Marengoni
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  3. Simona Ghibelli
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  4. Flavio Suardi
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  5. Codjo D. Djade
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  6. Alessandro Nobili
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Correspondence to Luca Pasina.

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Funding

No sources of funding were used in the conduct of this study or the preparation of this article.

Conflict of interest

Luca Pasina, Alessandra Marengoni, Simona Ghibelli, Flavio Suardi, Codjo D. Djade, Alessandro Nobili, Carlotta Franchi, and Gianbattista Guerrini have no conflicts of interest that are directly relevant to the content of this manuscript.

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Informed consent was not required for the purpose of this study.

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Pasina, L., Marengoni, A., Ghibelli, S. et al. A Multicomponent Intervention to Optimize Psychotropic Drug Prescription in Elderly Nursing Home Residents: An Italian Multicenter, Prospective, Pilot Study. Drugs Aging 33, 143–149 (2016). https://doi.org/10.1007/s40266-015-0336-z

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  • DOI: https://doi.org/10.1007/s40266-015-0336-z

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