Multistep tool is effective for discontinuing inappropriate medication use in the nursing home setting

A Multidisciplinary Multistep Medication Review (3MR) tool used in the nursing home setting is effective for discontinuing inappropriate medication in frail elderly patients without a decline in their well-being. Given that many nursing home patients take several long-term medications, this tool could provide practical guidance on how to operationalize deprescribing. The findings of a cluster randomized controlled trial are published in Annals of Internal Medicine.

Polypharmacy, or the coincident prescribing of at least five long-term medications, is associated with increased risk for inappropriate prescribing. Up to 40 percent of nursing home residents may receive one or more inappropriate drugs, the use of which has been associated with adverse events and hospitalizations. Deprescribing is the discontinuation of inappropriate medication use to manage polypharmacy. While the clinical problem is well-known, few interventions have focused on reducing inappropriate medication use.

Researchers from the University of Groningen and University Medical Center Groningen (The Netherlands) randomly assigned 426 nursing home residents recruited from 59 Dutch nursing home wards to an intervention to reduce inappropriate medication use or to usual care. The intervention, 3MR, consisted of an assessment of the patient perspective, medical history, analysis of medications, a meeting between the treating physician and the pharmacist, and implementation of medication changes. The intervention was performed once, with an evaluation four months later. The goal was to discontinue inappropriate medication during the study period and to examine the effects on nursing home residents' well-being.

The researchers found that a greater proportion of patients in the intervention group than in the control group successfully discontinued at least one drug without a decline in their well-being. Clinicians practicing in the nursing home should note that improvements in medication use can be facilitated by working in a multidisciplinary team with a pharmacist. The 3MR approach could be an efficient and effective tool for use in the nursing home setting.