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 - 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 -