Prescribing for older people is complex and can lead to inappropriate prescribing, as well as side effects from prescribed medication. With a growing number of older people in the population, strategies to improve prescribing in this group are needed. Older people living in care homes are particularly at risk from polypharmacy and inappropriate prescribing. In a recent article published in the journal Age and Ageing, Malar Loganathan and colleagues reviewed the effects of interventions to optimise prescribing for people living in care homes.
Four interventional strategies were identified from previously published research: staff education, multi-disciplinary team (MDT) meetings, pharmacist medication reviews and computerised clinical decision support systems (CDSSs). Complex educational programmes that focused on improving patients' behavioural management and drug prescribing were the most studied area, with six of eight studies highlighting an improvement in prescribing. Mixed results were found for pharmacist interventions. CDSSs were evaluated in two studies, with one showing a significant improvement in appropriate drug orders. Two of three studies examining MDT meetings found an overall improvement in appropriate prescribing.
The results were mixed and there was no one interventional strategy that has proved to be effective. Nevertheless, education including academic detailing seems to show most promise. A multi-faceted approach and clearer policy guidelines are likely to be required to improve prescribing for patients in care homes. With the number of people living in care homes in the UK expected to continue to increase, research on how to improve the safety, quality and appropriateness of prescribing in this group will be important area for future work.
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