Effect of an ongoing pharmacist service to reduce medicine-induced deterioration and adverse reactions in aged-care facilities (nursing homes): a multicentre, randomised controlled trial (the ReMInDAR trial)

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Abstract

Objective

To assess the effectiveness of a pharmacist-led intervention using validated tools to reduce medicine-induced deterioration and adverse reactions.

Design and setting

Multicenter, open-label parallel randomised controlled trial involving 39 Australian aged-care facilities.

Participants

Residents on ≥4 medicines or ≥1 anticholinergic or sedative medicine.

Intervention

Pharmacist-led intervention using validated tools to detect signs and symptoms of medicine-induced deterioration which occurred every 8 weeks over 12 months.

Comparator

Usual care (Residential Medication Management Review) provided by accredited pharmacists.

Outcomes

Primary outcome was change in Frailty Index at 12 months. Secondary outcomes included changes in cognition, 24-hour movement behaviour by accelerometry, grip strength, weight, adverse events and quality of life.

Results

248 persons (median age 87 years) completed the study; 120 in the interventionand, 128 in control arms. In total 575 pharmacist, sessions were undertaken in the intervention arm. There was no statistically significant difference for change in frailty between groups (mean difference: 0.009, 95% CI: −0.028, 0.009, P = 0.320). A significant difference for cognition was observed, with a mean difference of 1.36 point change at 12 months (95% CI: 0.01, 2.72, P = 0.048). Changes in 24-hour movement behaviour, grip strength, adverse events and quality of life were not significantly different between groups. Point estimates favoured the intervention arm at 12 months for frailty, 24-hour movement behaviour and grip strength.

Conclusions

The use of validated tools by pharmacists to detect signs of medicine-induced deterioration is a model of practice that requires further research, with promising results from this trial, particularly with regards to improved cognition.

Related collections

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Author and article information

Contributors

Elizabeth E Roughead

Nicole L Pratt

Gaynor Parfitt

Debra Rowett

Lisa M Kalisch-Ellett

Luke Bereznicki

Tracy Merlin

Megan Corlis

Ai Choo Kang

Joseph Whitehouse

Rebecca Bilton

Camille Schubert

Stacey Torode

Thu-Lan Kelly

Andre Q Andrade:

ORCID: https://orcid.org/0000-0001-6587-3169

Dannielle Post:

ORCID: https://orcid.org/0000-0002-8246-0363

Gereltuya Dorj

Justin Cousins

Mackenzie Williams

Renly Lim:

ORCID: https://orcid.org/0000-0003-4135-2523

Journal

Journal ID (nlm-ta): Age Ageing

Journal ID (iso-abbrev): Age Ageing

Journal ID (publisher-id): ageing

Title: Age and Ageing

Publisher: Oxford University Press

ISSN (Print): 0002-0729

ISSN (Electronic): 1468-2834

Publication date Collection: April 2022

Publication date (Electronic): 22 April 2022

Publication date PMC-release: 22 April 2022

Volume: 51

Issue: 4

Electronic Location Identifier: afac092