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Open AccessArticle

Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

1
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia
2
School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA 5005, Australia
3
NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia
4
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
5
Helping Hand Aged Care, Adelaide, SA 5006, Australia
6
Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, School of Medicine, University of Sydney, Sydney, NSW 2050, Australia
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2020, 9(4), 1053; https://doi.org/10.3390/jcm9041053
Received: 27 March 2020 / Accepted: 31 March 2020 / Published: 8 April 2020
(This article belongs to the Section Epidemiology & Public Health)
In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (−0.38, 95% confidence intervals (CI) −0.69 to −0.07) and 12 months (−0.47, 95%CI −0.84 to −0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57–5.53) or mortality (relative risk 0.81, 95%CI 0.48–1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement. View Full-Text
Keywords: cluster-randomized controlled trial; medication regimen simplification; residential aged care; nursing homes; long-term care; medication administration; incidents; falls; mortality; hospitalization cluster-randomized controlled trial; medication regimen simplification; residential aged care; nursing homes; long-term care; medication administration; incidents; falls; mortality; hospitalization
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Sluggett, J.K.; Hopkins, R.E.; Chen, E.Y.; Ilomäki, J.; Corlis, M.; Van Emden, J.; Hogan, M.; Caporale, T.; Ooi, C.E.; Hilmer, S.N.; Bell, J.S. Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial. J. Clin. Med. 2020, 9, 1053.

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