TY - JOUR
T1 - Effect of collaborative dementia care on potentially inappropriate medication use
T2 - Outcomes from the Care Ecosystem randomized clinical trial
AU - Liu, Amy K.
AU - Possin, Katherine L.
AU - Cook, Kristen M.
AU - Lynch, Shalini
AU - Dulaney, Sarah
AU - Merrilees, Jennifer J.
AU - Braley, Tamara
AU - Kiekhofer, Rachel E.
AU - Bonasera, Stephen J.
AU - Allen, Isabel E.
AU - Chiong, Winston
AU - Clark, Amy M.
AU - Feuer, Julie
AU - Ewalt, Joan
AU - Guterman, Elan L.
AU - Gearhart, Rosalie
AU - Miller, Bruce L.
AU - Lee, Kirby P.
N1 - Funding Information:
The authors acknowledge Dr. Michael Steinman for his advice on medical record data analysis and Caroline Prioleau for assistance with figures. We also thank our Care Team Navigators and staff research coordinators for their many efforts to bring these interventions to families living with dementia and patiently measuring the effects of these interventions, and the UCSF Memory and Aging Center Family Advisory Council for their input in designing the Care Ecosystem model of care. Finally, we greatly thank our study participants for their effort and time in testing and refining our interventions. This project was funded by the Department of Health and Human Services, Centers for Medicare & Medicaid Services (1C1CMS331346), the National Institute on Aging (5R01AG056715), and the Global Brain Health Institute. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication.
Funding Information:
Dr. Liu reported receiving grant funding from the National Institute of General Medicine Sciences (T32GM007546). Dr. Possin reported receiving grants from the National Institute of Neurological Disorders and Stroke, the National Institute on Aging, Global Brain Health Institute, Quest Diagnostics, Administration for Community Living, Rainwater Charitable Trust, and Merck Foundation; and personal fees from ClearView Health Partners and Vanguard. Dr. Chiong reported receiving grants from the National Institute on Mental Health and the National Institute on Aging. Dr. Guterman reported receiving grant funding from the National Institute of Neurological Disorders and Stroke (1K23NS116128‐01), National Institute on Aging (5R01AG056715), and American Academy of Neurology. She has received personal compensation from Marinus Pharmaceuticals, Inc., JAMA Neurology, and Remo Health, which are unrelated the submitted work. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services or any of its agencies. Author disclosures are available in the supporting information .
Funding Information:
The authors acknowledge Dr. Michael Steinman for his advice on medical record data analysis and Caroline Prioleau for assistance with figures. We also thank our Care Team Navigators and staff research coordinators for their many efforts to bring these interventions to families living with dementia and patiently measuring the effects of these interventions, and the UCSF Memory and Aging Center Family Advisory Council for their input in designing the Care Ecosystem model of care. Finally, we greatly thank our study participants for their effort and time in testing and refining our interventions. This project was funded by the Department of Health and Human Services, Centers for Medicare & Medicaid Services (1C1CMS331346), the National Institute on Aging (5R01AG056715), and the Global Brain Health Institute. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© 2022 the Alzheimer's Association.
PY - 2023/5
Y1 - 2023/5
N2 - Introduction: Potentially inappropriate medications (PIMs) cause adverse events and death. We evaluate the Care Ecosystem (CE) collaborative dementia care program on medication use among community-dwelling persons living with dementia (PLWD). Methods: Secondary analysis of a randomized clinical trial (RCT) comparing CE to usual care (UC) on changes in PIMs, over 12 months between March 2015 and May 2020. Secondary outcomes included change in number of medications, clinically relevant PIMs, and anti-dementia medications. Results: Of 804 PLWD, N = 490 had complete medication data. The CE resulted in significantly fewer PIMs compared to UC (−0.35; 95% CI, −0.49 to −0.20; P < 0.0001). Number needed to prevent an increase in 1 PIM was 3. Total medications, PIMs for dementia or cognitive impairment, CNS-active PIMs, anticholinergics, benzodiazepines, and opioids were also fewer. Anti-dementia medication regimens were modified more frequently. Conclusion: The CE medication review intervention embedded in collaborative dementia care optimized medication use among PLWD. Highlights: Compared to usual care (UC), the Care Ecosystem (CE) medication review intervention prevented increases in potentially inappropriate medications (PIMs). Use of anticholinergics, benzodiazepines, and opioids were significantly reduced, with a trend for antipsychotics. Anti-dementia medications were adjusted more frequently. The CE medication review intervention embedded in collaborative dementia care optimized medication use.
AB - Introduction: Potentially inappropriate medications (PIMs) cause adverse events and death. We evaluate the Care Ecosystem (CE) collaborative dementia care program on medication use among community-dwelling persons living with dementia (PLWD). Methods: Secondary analysis of a randomized clinical trial (RCT) comparing CE to usual care (UC) on changes in PIMs, over 12 months between March 2015 and May 2020. Secondary outcomes included change in number of medications, clinically relevant PIMs, and anti-dementia medications. Results: Of 804 PLWD, N = 490 had complete medication data. The CE resulted in significantly fewer PIMs compared to UC (−0.35; 95% CI, −0.49 to −0.20; P < 0.0001). Number needed to prevent an increase in 1 PIM was 3. Total medications, PIMs for dementia or cognitive impairment, CNS-active PIMs, anticholinergics, benzodiazepines, and opioids were also fewer. Anti-dementia medication regimens were modified more frequently. Conclusion: The CE medication review intervention embedded in collaborative dementia care optimized medication use among PLWD. Highlights: Compared to usual care (UC), the Care Ecosystem (CE) medication review intervention prevented increases in potentially inappropriate medications (PIMs). Use of anticholinergics, benzodiazepines, and opioids were significantly reduced, with a trend for antipsychotics. Anti-dementia medications were adjusted more frequently. The CE medication review intervention embedded in collaborative dementia care optimized medication use.
KW - anti-dementia medications
KW - dementia
KW - medication review
KW - pharmacist
KW - polypharmacy
KW - potentially inappropriate medications
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U2 - 10.1002/alz.12808
DO - 10.1002/alz.12808
M3 - Article
C2 - 36331050
AN - SCOPUS:85141409597
SN - 1552-5260
VL - 19
SP - 1865
EP - 1875
JO - Alzheimer's and Dementia
JF - Alzheimer's and Dementia
IS - 5
ER -