Impact of a nurse-based intervention on medication outcomes in vulnerable older adults

Michael A Steinman, Marcelo Low, Ran D Balicer, Efrat Shadmi, Michael A Steinman, Marcelo Low, Ran D Balicer, Efrat Shadmi

Abstract

Background: Medication-related problems are common in older adults with multiple chronic conditions. We evaluated the impact of a nurse-based primary care intervention, based on the Guided Care model of care, on patient-centered aspects of medication use.

Methods: Controlled clinical trial of the Comprehensive Care for Multimorbid Adults Project (CC-MAP), conducted among 1218 participants in 7 intervention clinics and 6 control (usual care) clinics. Inclusion criteria included age 45-94, presence of ≥3 chronic conditions, and Adjusted Clinical Groups (ACG) score > 0.19. The co-primary outcomes were number of changes to the medication regimen between baseline and 9 month followup, and number of changes to symptom-focused medications, markers of attentiveness to medication-related issues.

Results: Mean age in the intervention group was 72 years, 59% were women, and participants used a mean of 6.6 medications at baseline. The control group was slightly older (73 years) and used more medications (mean 7.1). Between baseline and 9 months, intervention subjects had more changes to their medication regimen than control subjects (mean 4.04 vs. 3.62 medication changes; adjusted difference 0.55, p = 0.001). Similarly, intervention subjects had more changes to their symptomatic medications (mean 1.38 vs. 1.26 changes, adjusted difference 0.20, p = 0.003). The total number of medications in use remained stable between baseline and follow-up in both groups (p > 0.18).

Conclusion: This nurse-based, primary care intervention resulted in substantially more changes to patients' medication regimens than usual care, without increasing the total number of medications used. This enhanced rate of change likely reflects greater attentiveness to the medication-related needs of patients.

Trial registration: This trial is registered at https://ichgcp.net/clinical-trials-registry/NCT01811173" title="See in ClinicalTrials.gov">NCT01811173 .

Keywords: Aged; Israel; Medication management; Multimorbidity; Polypharmacy; Primary care; Quality of care.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review boards of Clalit Health Services and the University of California, San Francisco. All subjects provided written informed consent to participate in the study.

Consent for publication

Not applicable.

Competing interests

Dr. Steinman has served as a consultant for iodine.com. Mr. Low and Drs Balicer and Shadmi report no conflicts.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CONSORT diagram. People who died within the first 9 months after enrollment could not be analyzed since 9-month medication outcome data were not available for these subjects

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