Introduction Prescribing in the elderly population is a complex process and the prevalence of inappropriate prescribing is high, with potentially severe consequences. Care home residents are particularly vulnerable to inappropriate prescribing. With a growing ageing population, strategies to improve prescribing are essential. The aim of this systematic review was to collect and interpret the results of controlled trials of interventions to reduce inappropriate prescribing in care homes, to determine the most effective strategies.
Method Databases searched were MEDLINE, EMBASE, international pharmaceutical abstracts and the Cochrane library. Search items included “nursing home”, “residential home”, “inappropriate prescribing”, “education”, “staff education”, “MDT”, “pharmacist”, “computer”. The search strategy retrieved 16 articles that met the inclusion criteria. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale. A meta-analysis could not be done due to heterogeneity of the outcome measures used in the different studies.
Results Four intervention strategies were indentified: education, multidisciplinary team (MDT) meetings, clinical pharmacist reviews and computerised clinical support systems. Educations interventions was the most studied area, with six studies showing an improvement in inappropriate prescribing. Mixed results were found for the pharmacist interventions, possibly due to the inappropriate choice of outcome measures used for assessing prescribing quality. Computerised decision support systems were evaluated in two studies, with one showing a significant increase in the final appropriate drug orders. Two of the three studies examining MDT meetings found an overall improvement in quality of prescribing.
Conclusion Results from various interventional strategies are mixed; a multi-faceted approach, clearer policy guidelines and standardised measurements for measuring inappropriate prescribing are required to improve prescribing practices for these vulnerable patients.
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