Effect of collaborative dementia care on potentially inappropriate medication use: Outcomes from the Care Ecosystem randomized clinical trial

Amy K. Liu, Katherine L. Possin, Kristen M. Cook, Shalini Lynch, Sarah Dulaney, Jennifer J. Merrilees, Tamara Braley, Rachel E. Kiekhofer, Stephen J. Bonasera, Isabel E. Allen, Winston Chiong, Amy M. Clark, Julie Feuer, Joan Ewalt, Elan L. Guterman, Rosalie Gearhart, Bruce L. Miller, Kirby P. Lee

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1865-1875
Number of pages11
JournalAlzheimer's and Dementia
Volume19
Issue number5
DOIs
StatePublished - May 2023

Keywords

  • anti-dementia medications
  • dementia
  • medication review
  • pharmacist
  • polypharmacy
  • potentially inappropriate medications

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Developmental Neuroscience
  • Clinical Neurology
  • Geriatrics and Gerontology
  • Cellular and Molecular Neuroscience
  • Psychiatry and Mental health

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