Special Issue "Improving Medication Safety and Effectiveness among Older People in Long-Term Care Settings"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: 1 July 2022.

Special Issue Editors

Dr. Janet K. Sluggett
E-Mail Website
Guest Editor
University of South Australia, UniSA Allied Health and Human Performance, Adelaide 5001, Australia
Interests: pharmacoepidemiology; long-term care; residential aged care; pharmacy; medication safety
Dr. Stephanie L. Harrison
E-Mail Website
Guest Editor
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
Interests: epidemiology; dementia; cardiovascular disease; long-term care
Dr. Edwin C. K. Tan
E-Mail Website
Guest Editor
Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney 2006, New South Wales, Australia
Interests: pharmacoepidemiology; ageing; dementia; quality use of medicines

Special Issue Information

Dear Colleagues,

Residents of long-term care facilities (LTCFs)—also known as nursing homes, care homes, or residential aged care facilities—are often exposed to polypharmacy and complex medication regimens. On admission to an LTCF, residents often receive care from a new medical practitioner. Most residents require assistance with medication administration from LTCF staff. These factors, together with resident characteristics such as older age, frailty, dementia, multimorbidity, and frequent care transitions, can place residents at greater risk of medication-related harm. Residents are often exposed to high-risk medications such as anticoagulants, hypoglycaemic medications, opioids and psychotropics. Ensuring that medications are used safely and effectively in older people, and reducing harm arising from high-risk medication use in LTCFs, is an international health priority area.

There is an urgent need to increase the evidence base relating to medication safety and effectiveness in LTCFs, and to develop strategies to enhance medication use in this under-researched setting. For this Special Issue of the International Journal of Environmental Research and Public Health, we invite original research manuscripts, reviews and case reports that focus on understanding and improving medication safety and effectiveness in older residents of LTCFs. Drug utilisation studies, longitudinal studies, comparative effectiveness research and studies examining interventions to enhance medication use in LTCFs are welcomed. Research into facility-level variations in medication use, and quality use of medicines at end-of-life in LTCFs are also invited.

Dr. Janet K. Sluggett
Dr. Stephanie L. Harrison
Dr. Edwin C. K. Tan
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • geriatric pharmacoepidemiology
  • long-term care
  • nursing homes
  • care transitions
  • medication safety
  • quality use of medicines
  • high risk medications
  • medication incidents
  • medication-related harm
  • quality improvement
  • deprescribing
  • medication review

Published Papers (2 papers)

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Research

Article
National Trends and Policy Impacts on Provision of Home Medicines Reviews and Residential Medication Management Reviews in Older Australians, 2009–2019
Int. J. Environ. Res. Public Health 2021, 18(18), 9898; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189898 - 20 Sep 2021
Viewed by 767
Abstract
Comprehensive medicines reviews such as Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) can resolve medicines-related problems. Changes to Australia’s longstanding HMR and RMMR programs were implemented between 2011 and 2014. This study examined trends in HMR and RMMR provision among [...] Read more.
Comprehensive medicines reviews such as Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) can resolve medicines-related problems. Changes to Australia’s longstanding HMR and RMMR programs were implemented between 2011 and 2014. This study examined trends in HMR and RMMR provision among older Australians during 2009–2019 and determined the impact of program changes on service provision. Monthly rates of general medical practitioner (GP) HMR claims per 1000 people aged ≥65 years and RMMR claims per 1000 older residents of aged care facilities were determined using publicly available data. Interrupted time series analysis was conducted to examine changes coinciding with dates of program changes. In January 2009, monthly HMR and RMMR rates were 0.80/1000 older people and 20.17/1000 older residents, respectively. Small monthly increases occurred thereafter, with 1.89 HMRs/1000 and 34.73 RMMRs/1000 provided in February 2014. In March 2014, immediate decreases of –0.32 (95%CI –0.52 to –0.11) HMRs/1000 and –12.80 (95%CI –15.22 to –10.37) RMMRs/1000 were observed. There were 1.07 HMRs/1000 and 35.36 RMMRs/1000 provided in December 2019. In conclusion, HMR and RMMR program changes in March 2014 restricted access to subsidized medicines reviews and were associated with marked decreases in service provision. The low levels of HMR and RMMR provision observed do not represent a proactive approach to medicines safety and effectiveness among older Australians. Full article
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Article
Process Evaluation of the SImplification of Medications Prescribed to Long-tErm Care Residents (SIMPLER) Cluster Randomized Controlled Trial: A Mixed Methods Study
Int. J. Environ. Res. Public Health 2021, 18(11), 5778; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115778 - 27 May 2021
Viewed by 1188
Abstract
Complex medication regimens are highly prevalent, burdensome for residents and staff, and associated with poor health outcomes in residential aged care facilities (RACFs). The SIMPLER study was a non-blinded, matched-pair, cluster randomized controlled trial in eight Australian RACFs that investigated the one-off application [...] Read more.
Complex medication regimens are highly prevalent, burdensome for residents and staff, and associated with poor health outcomes in residential aged care facilities (RACFs). The SIMPLER study was a non-blinded, matched-pair, cluster randomized controlled trial in eight Australian RACFs that investigated the one-off application of a structured 5-step implicit process to simplify medication regimens. The aim of this study was to explore the processes underpinning study implementation and uptake of the medication simplification intervention. A mixed methods process evaluation with an explanatory design was undertaken in parallel with the main outcome evaluation of the SIMPLER study and was guided by an established 8-domain framework. The qualitative component included a document analysis and semi-structured interviews with 25 stakeholders (residents, family, research nurses, pharmacists, RACF staff, and a general medical practitioner). Interviews were transcribed verbatim and reflexively thematically content analyzed. Descriptive statistics were used to summarize quantitative data extracted from key research documents. The SIMPLER recruitment rates at the eight RACFs ranged from 18.9% to 48.6% of eligible residents (38.4% overall). Participation decisions were influenced by altruism, opinions of trusted persons, willingness to change a medication regimen, and third-party hesitation regarding potential resident distress. Intervention delivery was generally consistent with the study protocol. Stakeholders perceived regimen simplification was beneficial and low risk if the simplification recommendations were individualized. Implementation of the simplification recommendations varied between the four intervention RACFs, with simplification implemented at 4-month follow-up for between 25% and 86% of residents for whom simplification was possible. Good working relationships between stakeholders and new remunerated models of medication management were perceived facilitators to wider implementation. In conclusion, the one-off implicit medication simplification intervention was feasible and generally delivered according to the protocol to a representative sample of residents. Despite variable implementation, recommendations to simplify complex regimens were valued by stakeholders, who also supported wider implementation of medication simplification in RACFs. Full article
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