Journal of the American Medical Directors Association
Original StudyEducation to Reduce Potentially Harmful Medication Use Among Residents of Assisted Living Facilities: A Randomized Controlled Trial
Section snippets
Design and Context
This was a RCT in which 20 wards in assisted living facilities in Helsinki, Finland, were randomized to intervention and control arms.33 The intervention was staff training on harmful medication use using the principles of constructive learning theory. Assisted living facilities provide medical and nursing care to people who are unable to live independently in the community. The level of care is similar to that provided in traditional nursing homes or long-term hospital wards, but the
Results
Of 307 eligible residents, 227 residents or their proxies provided consent to participate (Figure 1). The intervention group included 118 residents and the control group included 109 residents. There was a moderate attrition rate, with 41 residents (18.1%) lost to follow-up at 6 months. The total study attrition at 12 months was 63 residents (27.8%). This included 63 deaths (39 intervention residents, 24 control residents). In addition, data collection was not possible for 3 residents at the
Discussion
This RCT demonstrated that a relatively light educational intervention in assisted living facilities reduced prescribing of potentially harmful medications, maintained HRQoL and reduced hospitalization. To our knowledge, this is the first RCT to demonstrate an educational initiative to reduce potentially harmful medication use was associated with maintenance of residents' quality of life and lower use of hospital services.
An important strength of this study was its pragmatic design. The light
Conclusions
It is possible to reduce the number of harmful medications in institutionalized settings by educating nurses to identify harmful medications and ADEs. Modern activating learning methods directed at nurses in charge of residents' comprehensive care can maintain HRQoL and reduce hospitalization. The education initiative did not have a detectable impact on mortality.
Acknowledgments
The authors thank Helsinki City Social Services Department for its support.
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Dr Pitkälä reports having professional cooperation including lecturing fees from pharmaceutical and other health care companies (including Lundbeck, Orion), and having participated in clinical trials funded by pharmaceutical companies. Dr Juola, Dr Kautiainen, Dr Soini, Dr Finne-Soveri, Dr Bell, and Dr Björkman have no competing interests. This study is supported by Sohlberg Foundation and Helsinki University Hospital development grant.
Trial registration: ACTRN12611001078943.
The authors declare no conflicts of interest.