Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.

Hdl Handle:
http://hdl.handle.net/10147/206321
Title:
Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.
Authors:
Pope, George; Wall, Noreen; Peters, Catherine Mary; O'Connor, Margaret; Saunders, Jean; O'Sullivan, Catherine; Donnelly, Teresa M; Walsh, Thomas; Jackson, Steven; Lyons, Declan; Clinch, David
Affiliation:
Mid Western Regional Hospital, Clinical Age Assessment Unit, Limerick, Ireland., georgepopea@gmail.com
Citation:
Age Ageing. 2011 May;40(3):307-12. Epub 2010 Sep 4.
Journal:
Age and ageing
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/206321
DOI:
10.1093/ageing/afq095
PubMed ID:
20817937
Abstract:
OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.
Language:
eng
MeSH:
Activities of Daily Living; Aged; Continuity of Patient Care/*economics; Cost-Benefit Analysis; *Drug Utilization Review; *Geriatric Assessment; Geriatrics; Humans; Long-Term Care/*economics; Middle Aged; Outcome and Process Assessment (Health Care); Patient Care Team/*economics; Prospective Studies; Residential Facilities
ISSN:
1468-2834 (Electronic); 0002-0729 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorPope, Georgeen_GB
dc.contributor.authorWall, Noreenen_GB
dc.contributor.authorPeters, Catherine Maryen_GB
dc.contributor.authorO'Connor, Margareten_GB
dc.contributor.authorSaunders, Jeanen_GB
dc.contributor.authorO'Sullivan, Catherineen_GB
dc.contributor.authorDonnelly, Teresa Men_GB
dc.contributor.authorWalsh, Thomasen_GB
dc.contributor.authorJackson, Stevenen_GB
dc.contributor.authorLyons, Declanen_GB
dc.contributor.authorClinch, Daviden_GB
dc.date.accessioned2012-01-31T16:47:45Z-
dc.date.available2012-01-31T16:47:45Z-
dc.date.issued2012-01-31T16:47:45Z-
dc.identifier.citationAge Ageing. 2011 May;40(3):307-12. Epub 2010 Sep 4.en_GB
dc.identifier.issn1468-2834 (Electronic)en_GB
dc.identifier.issn0002-0729 (Linking)en_GB
dc.identifier.pmid20817937en_GB
dc.identifier.doi10.1093/ageing/afq095en_GB
dc.identifier.urihttp://hdl.handle.net/10147/206321-
dc.description.abstractOBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.en_GB
dc.language.isoengen_GB
dc.subject.meshActivities of Daily Livingen_GB
dc.subject.meshAgeden_GB
dc.subject.meshContinuity of Patient Care/*economicsen_GB
dc.subject.meshCost-Benefit Analysisen_GB
dc.subject.mesh*Drug Utilization Reviewen_GB
dc.subject.mesh*Geriatric Assessmenten_GB
dc.subject.meshGeriatricsen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLong-Term Care/*economicsen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshOutcome and Process Assessment (Health Care)en_GB
dc.subject.meshPatient Care Team/*economicsen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshResidential Facilitiesen_GB
dc.titleSpecialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.en_GB
dc.contributor.departmentMid Western Regional Hospital, Clinical Age Assessment Unit, Limerick, Ireland., georgepopea@gmail.comen_GB
dc.identifier.journalAge and ageingen_GB
dc.description.provinceMunster-
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