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

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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: closed (1 July 2022) | Viewed by 6789

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Special Issue Editors

Dr. Janet K. Sluggett

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Guest Editor

1. UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia
2. The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5001, Australia
Interests: geriatric pharmacoepidemiology; dementia; quality use of medicines; medication safety; long-term care; comprehensive medication reviews; aged care quality and safety
Special Issues, Collections and Topics in MDPI journals

Dr. Stephanie L. Harrison

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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

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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 submissions that pass pre-check are 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 monthly 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 2500 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

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17 pages, 489 KiB

Open AccessArticle

Process Evaluation of the SImplification of Medications Prescribed to Long-tErm Care Residents (SIMPLER) Cluster Randomized Controlled Trial: A Mixed Methods Study

by Janet K. Sluggett, Georgina A. Hughes, Choon Ean Ooi, Esa Y. H. Chen, Megan Corlis, Michelle E. Hogan, Tessa Caporale, Jan Van Emden and J. Simon Bell

Int. J. Environ. Res. Public Health 2021, 18(11), 5778; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115778 - 27 May 2021

Cited by 7 | Viewed by 3004

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 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

(This article belongs to the Special Issue Improving Medication Safety and Effectiveness among Older People in Long-Term Care Settings)

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Review

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17 pages, 880 KiB

Open AccessReview

How Do Pharmacists Practice in Aged Care? A Narrative Review of Models from Australia, England, and the United States of America

by Ibrahim Haider, Mark Naunton, Rachel Davey, Gregory M. Peterson, Wasim Baqir and Sam Kosari

Int. J. Environ. Res. Public Health 2021, 18(23), 12773; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312773 - 03 Dec 2021

Cited by 13 | Viewed by 2746

Abstract

Medication management in residential aged care facilities (RACFs) is complex and often sub-optimal. Pharmacist practice models and services have emerged internationally to address medication-related issues in RACFs. This narrative review aimed to explore pharmacist practice models in aged care in Australia, England and the USA, and identify key activities and characteristics within each model. A search strategy using key terms was performed in peer-reviewed databases, as well as the grey literature. Additionally, experts from the selected countries were consulted to obtain further information about the practice models in their respective countries. Thirty-six documents met the inclusion criteria and were included in the review. Four major pharmacist practice models were identified and formed the focus of the review: (1) the NHS’s Medicine Optimisation in Care Homes (MOCH) program from England; (2) the Australian model utilising visiting accredited pharmacists; (3) the Centers for Medicare and Medicaid (CMS) pharmacy services in long-term care from the USA; and (4) the Medication Therapy Management (MTM) program from the USA. Medication reviews were key activities in all models, but each had distinct characteristics in relation to the comprehensiveness, who is eligible, and how frequently residents receive medication review activity. There was heterogeneity in the types of facility-level activities offered by pharmacists, and further research is needed to determine the effectiveness of these activities in improving quality use of medicines in the aged care setting. This review found that in some models, pharmacists have a limited level of collaboration with other healthcare professionals, emphasising the need to trial innovative models with integrated services and increased collaboration to achieve a holistic patient-centred approach to medication management. Full article

(This article belongs to the Special Issue Improving Medication Safety and Effectiveness among Older People in Long-Term Care Settings)

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