Multicomponent intervention to tailor prescriptions to patients with dementia in an intermediate care hospital: pre-post quasi experimental study.

Abstract

Objectives: In persons with dementia, polypharmacy may be discordant with the goals of care. It is necessary to design interventions that align treatment regimens with the patient's situation, prognosis and preferences. The objectives of this study conducted at an intermediate care were to: i) identify inappropriate prescribing per the main care goal; ii) compare the pharmacotherapy data pre and post a medication review based on the degree of cognitive impairment; iii) assess the implementation of the proposed prescribing recommendations three months after discharge.

Design: Pre-post quasi-experimental study.

Setting and participants: Patients with dementia discharged from an intermediate care hospital between November 2021 and April 2022.

Methods: Demographic, clinical and pharmacotherapy data were evaluated at admission. Medication reviews and interviews with the caregivers were conducted to align pharmacologic therapies with the overall goals of care. At discharge, information on the proposed prescribing recommendations was shared with the primary care team in the discharge summary. Follow up to evaluate implementation of the prescribing recommendations proposed during the medication review was performed at three months.

Results: Of the 97 patients included, 94.8% had at least one inappropriately prescribed medication. At discharge, the mean number of chronic medications taken per patient decreased by 29.6%, from 8.05(SD 3.5) to 5.67(SD 2.7) (p < 0.001); the anticholinergic burden decreased by 18.6%, from 1.59(SD 1.0) to 1.29(SD 0.9) (p < 0.001); and therapeutic complexity decreased by 28.4%, from 29.23(SD 13.8) to 20.94(SD 11.3) (p < 0.001). At 3 months implementation of the proposed prescribing recommendations was 90.0%.

Conclusions and implications: Admission to an intermediate care hospital provides the ideal setting for a multicomponent intervention, tailoring prescriptions to the patient's overall goals of care and preferences, improving the pharmacotherapy parameters related to side effects, and ensuring that the proposed prescribing recommendations are maintained over the medium term.