Effect of collaborative dementia care on potentially inappropriate medication use: Outcomes from the Care Ecosystem randomized clinical trial

Alzheimer's & dementia : the journal of the Alzheimer's Association

Alzheimers Dement. 2022 Nov 4. doi: 10.1002/alz.12808. Online ahead of print.

ABSTRACT

INTRODUCTION: Potentially inappropriate medications (PIMs) cause adverse events and death. We evaluate the Care Ecosystem (CE) collaborative dementia care program on medication use among community-dwelling persons living with dementia (PLWD).

METHODS: Secondary analysis of a randomized clinical trial (RCT) comparing CE to usual care (UC) on changes in PIMs, over 12 months between March 2015 and May 2020. Secondary outcomes included change in number of medications, clinically relevant PIMs, and anti-dementia medications.

RESULTS: Of 804 PLWD, N = 490 had complete medication data. The CE resulted in significantly fewer PIMs compared to UC (-0.35; 95% CI, -0.49 to -0.20; P < 0.0001). Number needed to prevent an increase in 1 PIM was 3. Total medications, PIMs for dementia or cognitive impairment, CNS-active PIMs, anticholinergics, benzodiazepines, and opioids were also fewer. Anti-dementia medication regimens were modified more frequently.

CONCLUSION: The CE medication review intervention embedded in collaborative dementia care optimized medication use among PLWD.

HIGHLIGHTS: Compared to usual care (UC), the Care Ecosystem (CE) medication review intervention prevented increases in potentially inappropriate medications (PIMs). Use of anticholinergics, benzodiazepines, and opioids were significantly reduced, with a trend for antipsychotics. Anti-dementia medications were adjusted more frequently. The CE medication review intervention embedded in collaborative dementia care optimized medication use.

PMID:36331050 | DOI:10.1002/alz.12808

Authors

Amy K Liu
Katherine L Possin
Kristen M Cook
Shalini Lynch
Sarah Dulaney
Jennifer J Merrilees
Tamara Braley
Rachel E Kiekhofer
Stephen J Bonasera
Isabel E Allen
Winston Chiong
Amy M Clark
Julie Feuer
Joan Ewalt
Elan L Guterman
Rosalie Gearhart
Bruce L Miller
Kirby P Lee