An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing

Age Ageing. 2004 Nov;33(6):612-7. doi: 10.1093/ageing/afh213. Epub 2004 Sep 22.


Background: efficient strategies are needed to provide specialist advice in nursing homes to ensure quality medical care. We describe a case conference intervention involving a multidisciplinary team of health professionals.

Objectives: to evaluate the impact of multidisciplinary case conferences on the appropriateness of medications and on patient behaviours in high-level residential aged care facilities.

Design: cluster-randomised controlled trial.

Setting: ten high-level aged care facilities.

Participants: 154 residents with medication problems and/or challenging behaviours were selected for case conference by residential care staff.

Intervention: two multidisciplinary case conferences involving the resident's general practitioner, a geriatrician, a pharmacist and residential care staff were held at the nursing home for each resident.

Measurements: outcomes were assessed at baseline and 3 months. The primary outcome was the Medication Appropriateness Index (MAI). The behaviour of each resident was assessed via the Nursing Home Behaviour Problem Scale.

Results: 45 residents died before follow-up. Medication appropriateness improved in the intervention group [MAI mean change 4.1, 95% confidence interval (CI) 2.1-6.1] compared with the control group (MAI mean change 0.4, 95% CI -0.4-1.2; P < 0.001). There was a significant reduction in the MAI for benzodiazepines (mean change control -0.38, 95% CI -1.02-0.27 versus intervention 0.73, 95% CI 0.16-1.30; P = 0.017). Resident behaviours were unchanged after the intervention and the improved medication appropriateness did not extend to other residents in the facility.

Conclusion: multidisciplinary case conferences in nursing homes can improve care. Outreach specialist services can be delivered without direct patient contact and achieve improvements in prescribing.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cluster Analysis
  • Cost-Benefit Analysis
  • Drug Costs
  • Drug Therapy / economics
  • Drug Therapy / standards*
  • Drug Utilization Review*
  • Female
  • Follow-Up Studies
  • Health Services Research
  • Homes for the Aged / standards*
  • Humans
  • Interdisciplinary Communication
  • Male
  • Nursing Homes / standards*
  • Patient Care Team*
  • Regression Analysis