Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial

Janet K. Sluggett, Esa Y.H. Chen, Jenni Ilomäki, Megan Corlis, Jan Van Emden, Michelle Hogan, Tessa Caporale, Claire Keen, Ria Hopkins, Choon Ean Ooi, Sarah N. Hilmer, Georgina A. Hughes, Andrew Luu, Kim Huong Nguyen, Tracy Comans, Susan Edwards, Lyntara Quirke, Allan Patching, J. Simon Bell

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Objective: To assess the application of a structured process to consolidate the number of medication administration times for residents of aged care facilities. Design: A nonblinded, matched-pair, cluster randomized controlled trial. Setting and Participants: Permanent residents who were English-speaking and taking at least 1 regular medication, recruited from 8 South Australian residential aged care facilities (RACFs). Methods: The intervention involved a clinical pharmacist applying a validated 5-step tool to identify opportunities to reduce medication complexity (eg, by administering medications at the same time or through use of longer-acting or combination formulations). Residents in the comparison group received routine care. The primary outcome at 4-month follow-up was the number of administration times per day for medications charted regularly. Resident satisfaction and quality of life were secondary outcomes. Harms included falls, medication incidents, hospitalizations, and mortality. The association between the intervention and primary outcome was estimated using linear mixed models. Results: Overall, 99 residents participated in the intervention arm and 143 in the comparison arm. At baseline, the mean resident age was 86 years, 74% were female, and medications were taken an average of 4 times daily. Medication simplification was possible for 62 (65%) residents in the intervention arm, with 57 (62%) of 92 simplification recommendations implemented at follow-up. The mean number of administration times at follow-up was reduced in the intervention arm in comparison to usual care (−0.36, 95% confidence interval −0.63 to −0.09, P =.01). No significant changes in secondary outcomes or harms were observed. Conclusions and Implications: One-off application of a structured tool to reduce regimen complexity is a low-risk intervention to reduce the burden of medication administration in RACFs and may enable staff to shift time to other resident care activities.

Original languageEnglish
Pages (from-to)1114-1120
Number of pages11
JournalJournal of the American Medical Directors Association
Volume21
Issue number8
DOIs
Publication statusPublished - Aug 2020

Keywords

  • Cluster randomized controlled trial
  • long-term care
  • medication administration
  • medication regimen simplification
  • nursing homes
  • residential aged care

Cite this