Impact of a nurse-based intervention on medication outcomes in vulnerable older adults

Michael A. Steinman, Marcelo Low, Ran D. Balicer, Efrat Shadmi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Medication-related problems are common in older adults with multiple chronic conditions. We evaluated the impact of a nurse-based primary care intervention, based on the Guided Care model of care, on patient-centered aspects of medication use. Methods: Controlled clinical trial of the Comprehensive Care for Multimorbid Adults Project (CC-MAP), conducted among 1218 participants in 7 intervention clinics and 6 control (usual care) clinics. Inclusion criteria included age 45-94, presence of ≥3 chronic conditions, and Adjusted Clinical Groups (ACG) score > 0.19. The co-primary outcomes were number of changes to the medication regimen between baseline and 9 month followup, and number of changes to symptom-focused medications, markers of attentiveness to medication-related issues. Results: Mean age in the intervention group was 72 years, 59% were women, and participants used a mean of 6.6 medications at baseline. The control group was slightly older (73 years) and used more medications (mean 7.1). Between baseline and 9 months, intervention subjects had more changes to their medication regimen than control subjects (mean 4.04 vs. 3.62 medication changes; adjusted difference 0.55, p = 0.001). Similarly, intervention subjects had more changes to their symptomatic medications (mean 1.38 vs. 1.26 changes, adjusted difference 0.20, p = 0.003). The total number of medications in use remained stable between baseline and follow-up in both groups (p > 0.18). Conclusion: This nurse-based, primary care intervention resulted in substantially more changes to patients' medication regimens than usual care, without increasing the total number of medications used. This enhanced rate of change likely reflects greater attentiveness to the medication-related needs of patients.

Original languageEnglish
Article number207
JournalBMC Geriatrics
Volume18
Issue number1
DOIs
StatePublished - 6 Sep 2018

Bibliographical note

Funding Information:
This work was supported by the Gertner Institute, Clalit Health Services, and by the University of California San Francisco Research Allocation Program. The sponsors had no role in the study design, methods, subject recruitment, data collection, analysis, preparation of manuscripts, or the decision to publish.

Publisher Copyright:
© 2018 The Author(s).

Keywords

  • Aged
  • Israel
  • Medication management
  • Multimorbidity
  • Polypharmacy
  • Primary care
  • Quality of care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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