• Age and ageing · Nov 2004

    Randomized Controlled Trial Clinical Trial

    An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing.

    • Maria Crotty, Julie Halbert, Debra Rowett, Lynne Giles, Robert Birks, Helena Williams, and Craig Whitehead.
    • Flinders University Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia 5041, Australia. Maria.Crotty@flinders.edu.au
    • Age Ageing. 2004 Nov 1;33(6):612-7.

    Backgroundefficient strategies are needed to provide specialist advice in nursing homes to ensure quality medical care. We describe a case conference intervention involving a multidisciplinary team of health professionals.Objectivesto evaluate the impact of multidisciplinary case conferences on the appropriateness of medications and on patient behaviours in high-level residential aged care facilities.Designcluster-randomised controlled trial.Settingten high-level aged care facilities.Participants154 residents with medication problems and/or challenging behaviours were selected for case conference by residential care staff.Interventiontwo multidisciplinary case conferences involving the resident's general practitioner, a geriatrician, a pharmacist and residential care staff were held at the nursing home for each resident.Measurementsoutcomes were assessed at baseline and 3 months. The primary outcome was the Medication Appropriateness Index (MAI). The behaviour of each resident was assessed via the Nursing Home Behaviour Problem Scale.Results45 residents died before follow-up. Medication appropriateness improved in the intervention group [MAI mean change 4.1, 95% confidence interval (CI) 2.1-6.1] compared with the control group (MAI mean change 0.4, 95% CI -0.4-1.2; P < 0.001). There was a significant reduction in the MAI for benzodiazepines (mean change control -0.38, 95% CI -1.02-0.27 versus intervention 0.73, 95% CI 0.16-1.30; P = 0.017). Resident behaviours were unchanged after the intervention and the improved medication appropriateness did not extend to other residents in the facility.Conclusionmultidisciplinary case conferences in nursing homes can improve care. Outreach specialist services can be delivered without direct patient contact and achieve improvements in prescribing.

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