Improving medication use of nursing home residents with a life-limiting disease: a symptom-driven approach to multidisciplinary medication review
Polypharmacy or the chronic use of 5 or more drugs with systemic effect is common in nursing homes, especially in residents with a life-limiting disease (LLD). Four categories of medication are involved: medication to treat their LLD, drugs for symptom management, drugs for long-term prevention of e.g. cardiovascular disease and drugs for treatment of co-morbidities such as diabetes. In accordance with the definition of palliative care as an approach that improves quality of life of patients and their families facing the problems associated with LLD, care goals in residents with LLD should change from cure to care and from quantity to quality of life (QoL). Moreover, the focus of their care should shift from disease-oriented to QoL-oriented as well as patient-centered. Regarding medication use in advanced stages of disease, this means treating symptoms which are currently undertreated, preventing possible harm caused by e.g. adverse drug reactions (ADRs), deprescribing of drugs without short term benefits, and finally, involving residents and their families in the medication review process. However, in adults with LLD, no patient-centered interventions or tools exist to support medication review at the end of life with a specific focus on symptom relief, i.e. treating symptoms which are undertreated and avoiding possible harm owing to medication use. Existing interventions to support medication review mainly focus on a specific group of healthcare providers, such as physicians (e.g. STOPP/START), pharmacists (e.g.GheOP3S) or nurses (e.g. Pharmanurse).
The aim of this research is to adapt the latter existing complex intervention, Pharmanurse into PharmaNurse+ for application in nursing home residents with advanced disease and limited life-expectancy. The purpose of this complex intervention is to improve medication use of nursing home residents with LLD by means of a symptom-driven approach, based on monitoring by nurses, to multidisciplinary medication review. We will follow the international framework for development and evaluation of complex interventions to improve health from the Medical Research Council to adapt Pharmanurse to the new context. Furthermore, we will test this adapted intervention, PharmaNurse+ in a Phase II trial.