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An Algorithm for Comprehensive Medication Management in Nursing Homes: Results of the AMBER Project

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Abstract

Introduction

There are several barriers to conducting medication management in nursing homes. Our project aimed to develop an algorithm that guides and supports pharmacists to perform this clinical service.

Methods

Phase I of the project examined the practitioner and patient perspectives on the medication process in nursing homes. The mixed methods approach consisted of interviews with qualitative content analysis and a quantitative questionnaire. Phase IIa scoped existing research and comprised a three-stepped systematic review. It was registered in the International Prospective Register of Systematic Reviews (CRD42017065002). Results of the first two steps were assessed for quality. Phase IIb was performed as a Delphi survey. The developed algorithm was tested in nursing homes. The primary endpoint was the number and type of detected drug-related problems. The study was conducted between June 2016 and December 2018 (Deutsches-Register-Klinischer-Studien-ID: DRKS00010995).

Results

Interviews were held with 21 healthcare practitioners and six patients. Frequent and relevant aspects of the medication process in nursing homes were identified. The systematic reviews included 28 reviews, 12 interventional studies and 1450 non-interventional studies. As a result of the Delphi survey, two new aspects were added. Testing of the drafted algorithm was done in 73 nursing home residents. A mean of 6.3 drug-related problems were detected. Sample cases were executed in a mean time of 21 min by community pharmacists.

Conclusions

The developed and consented algorithm can guide pharmacists in conducting medication management in a timely and effective manner. It might serve as a facilitator to improve collaboration and quality of medication in nursing home residents.

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Acknowledgements

The AMBER project needs to thank the participating nursing homes, patients, pharmacists, physicians and nurses, without whom it would not have been possible. The authors would like to thank Dr. Sebastian Baum, Dr. Dolf Hage, Dr. Heinz Giesen, Laura Kerschke, M.Sc., Prof. Dr. Hugo Mennemann and Dr. Udo Puteanus for their valuable contributions, and the Apothekerstiftung Westfalen-Lippe for funding.

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Authors and Affiliations

  1. Elefanten-Apotheke gegr. 1575, Steinstr. 14, 48565, Steinfurt, Germany

    Susanne Erzkamp

  2. Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str. 21 Gebäude FN (1. OG), 42119, Wuppertal, Germany

    Juliane Köberlein-Neu

  3. impac2t Research, Maximilianstr. 31-33, 48147, Muenster, Germany

    Olaf Rose

  4. Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1225 Center Drive HPNP Bldg, Gainesville, FL, 32610-0486, USA

    Olaf Rose

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Correspondence to Olaf Rose.

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Funding

The AMBER project was supported by the Apothekerstiftung Westfalen-Lippe. There was no involvement of the funding party in the study and its outcomes.

Conflict of interest

Juliane Koeberlein-Neu, Susanne Erzkamp and Olaf Rose declare that they have no competing interests and received no financial support for the conduct of this study.

Ethics approval

The regional ethics committee of the Medical Association of Westphalia-Lippe and the University of Muenster approved the study (registration number 2017-350-f-S). The study was registered at the German Clinical Trials Register (DRKS-ID: DRKS00010995).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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All authors consent to publication of this paper.

Availability of data and material (data transparency)

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Ethics

The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00010995, August 23, 2017). The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42017065002, May 5, 2017). Ethics approval by the Medical Association of Westphalia-Lippe and the University of Muenster (registration number 2017-350-f-S). The study protocol was published previously (Erzkamp S, Rose O. Development and evaluation of an algorithm-based tool for Medication Management in nursing homes: The AMBER study protocol. BMJ Open 2018;8(4):e019398).

Author contributions

SE and OR initiated the project; SE, JKN and OR were responsible for design and methodology; SE carried out the interviews, systematic reviews and Delphi survey with support from OR where needed; OR took the lead in writing the manuscript; all authors read, discussed and approved the manuscript.

Electronic supplementary material

Below is the link to the electronic supplementary material.

40264_2020_1016_MOESM1_ESM.pdf

Supplementary file 1: Questionnaires. Supplementary file 2: PRISMA-P checklist. Supplementary file 3: Search strategies. Supplementary file 4: Baselines of the interviewees and results of the interviews. Supplementary file 5: Summarized results of the interventional studies (systematic review step 2). Supplementary file 6: Indications and number of studies on non-interventional records (systematic review step 3) (PDF 2242 kb)

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Erzkamp, S., Köberlein-Neu, J. & Rose, O. An Algorithm for Comprehensive Medication Management in Nursing Homes: Results of the AMBER Project. Drug Saf 44, 313–325 (2021). https://doi.org/10.1007/s40264-020-01016-0

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