If you’re seeking to reduce hospital admissions among those with dementia, involving a clinical pharmacist on the healthcare team may help, according to new research from Sweden.
Clinical pharmacist and Umea University doctoral student and lecturer Maria Gustafsson performed a randomized, controlled trial that included 460 people in northern Sweden who were aged 65 or more years and who had dementia or cognitive impairment. At some point, each had been admitted to a hospital between 2012 and 2015. Gustafsson found that the admissions of as many as 41% of those in the study were related to medication events.
“The most common problem is adverse drug reaction, but also excessively high dosage and noncompliance is, unfortunately, common,” she said in a statement.
In an intervention, clinical pharmacists participated in healthcare teams, controlling whether individuals’ drug lists were correct and complete. The pharmacists also looked at all the drugs a person was taking and suggested potential improvements to the physician in charge, and also initiated discussions in the healthcare team.
“The results after the intervention showed that clinical pharmacists’ participation in healthcare teams reduced the risk of drug-related hospital readmissions by half during the follow-up time of 180 days,” Gustafsson said.
The study also demonstrated that antipsychotic and other psychotropic drugs were common among people with dementia in specialized care units. The drugs also were used for long periods of time, which is inconsistent with prevailing treatment guidelines.
“Drug treatment-related problems in elderly people with dementia are very common, and more work is needed to prevent, identify and treat these problems in this part of the population,” Gustafsson said. She performed the study for her dissertation (PDF).
Not just Sweden
Medication issues are a challenge in the United States, too, Brookdale Senior Living Chief Medical Officer Kevin O’Neil, M.D., recently said in a session at the National Investment Center for Seniors Housing & Care 2016 Spring Investment Forum.
When it comes to avoidable hospital admissions among older adults, he said, “Most of these admissions, these hospitalizations, are related to medication mishaps. Adverse drug events kill more people in the United States than motor vehicle accidents, HIV and breast cancer.”
While testing the effectiveness of INTERACT communication tools adapted for assisted living using a $7.3 million grant from the Centers for Medicare & Medicaid Services’ Innovation Center, Brookdale discovered that 60% of readmissions for heart failure were related to medication “screw-ups” or lack of adherence, he said.
Brookdale has found another solution. The “Stop and Watch” and SBAR (Situation, Background, Assessment, Recommendation) communication tools, as well as an advance care planning tool that are part of the evidence-based INTERACT (Interventions to Reduce Acute Care Transfers) assessment program, helped reduce hospitalizations by 17% and emergency department visits by 20% among residents of 46 Brookdale assisted living communities where the tools were tested over several years, according to Brookdale. The reductions were not solely related to medication-related challenges and were not restricted to people with dementia.
