BACKGROUND: Medication management interventions are designed to reduce medication-related harms in older people with dementia; however, their effect on healthcare utilisation remains unclear.
OBJECTIVE: To summarise the impact of medication management interventions on healthcare utilisation in people with dementia.
DATA SOURCES: Embase, MEDLINE, Web of Science, Cochrane CENTRAL Register of Controlled Trials, CINAHL, PsycINFO.
STUDY SELECTION: Interventional studies assessing the impact of medication management interventions on healthcare utilisation in people with dementia aged =65.
DATA EXTRACTION AND SYNTHESIS: Eligible randomised controlled trials (RCTs) were meta-analysed with risk ratios (RR), 95% confidence intervals (CIs) using a fixed-effect model. Outcomes from non-randomised studies were summarised through narrative synthesis.
MAIN OUTCOMES: Healthcare utilisation, including hospitalisation, emergency department visits, primary care and residential aged care home admissions.
RESULTS: Seven RCTs and five non-randomised studies were eligible for inclusion. Common interventions were physician education (n = 5), physician and patient/carer education (n = 2), physician targeted prescribing reminders (n = 1) and multidisciplinary team-based interventions (n = 5). Among these, physician and patient/carer targeted education resulted in a reduction in all-cause hospitalisation (RR =0.92, 95% CI [0.84-0.99], P = .04) and emergency department visits (RR = 0.92, 95% CI [0.86-0.98], P = .007) while multidisciplinary team-based interventions were effective in reducing drug-related hospital readmission (Hazard Ratio = 0.49, 95% CI [0.27-0.90], P = .02).
CONCLUSION: This review found that physician and patient/carer targeted education showed the most promising effect on all-cause hospitalisation and emergency department visits. Future research should develop tailored educational interventions that address key aspects of medication management to optimise healthcare utilisation in people with dementia.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
The elderly and those with dementia use many medications because of multimorbidity. This review showed that educating the carer helps reduce hospitalizations and emergency room visits from medication problems. In our facility, we have a medication management clinic. I think a research project along the lines suggested by the article may be in order.
, McMaster University