Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes

Aims To evaluate whether year long clinical pharmacy program involving deve lopment of professional relationships, nurse education on medication issues , and individualized medication reviews could change drug use, mortality an d morbidity in nursing home residents. Methods A cluster randomised controlled trial, where an intervention home w as matched to three control homes, was used to examine the effect of the cl inical pharmacy intervention on resident outcomes. The study involved 905 r esidents in 13 intervention nursing homes and 2325 residents in 39, control nursing homes in southeast Queensland and north-east New South Wales, Aust ralia. The outcome measures were. continuous drug use data from government prescription subsidy claims, cross-sectional drug use data on prescribed an d administered medications, deaths and morbidity indices (hospitalization r ates, adverse events and disability indices). Results This intervention resulted in a reduction in drug use with no chang e in morbidity indices or survival. Differences in nursing home characteris tics as defined by cluster analysis with SUDAAN(R). negated intervention-re lated apparent significant improvements in survival. The use of benzodiazep ines, nonsteroidal anti-inflammatory drugs. laxatives, histamine H-2-recept or antagonists and antacids was significantly reduced in the intervention g roup, whereas the use of digoxin and diuretics remained similar to controls . Overall, drug use in the intervention group was reduced by 14.8%, relativ e to the controls, equivalent to an annual prescription saving of $A64 per resident (approximately pound 25). Conclusions This intervention improved nursing home resident outcomes relat ed to changes in drug use and drug-related expenditure. The continuing dive rgence in both drug use and survival at the end of the study suggests that the difference would have been more significant in a larger and longer stud y, and even more so using additional instruments specific for measuring out comes related to changes in drug use.