title: An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing.
abstract: 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.
  
  
  OBJECTIVE
  to evaluate the impact of multidisciplinary case conferences on the appropriateness of medications and on patient behaviours in high-level residential aged care facilities.
  
  
  METHODS
  cluster-randomised controlled trial.
  
  
  METHODS
  ten high-level aged care facilities.
  
  
  METHODS
  154 residents with medication problems and/or challenging behaviours were selected for case conference by residential care staff.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  multidisciplinary case conferences in nursing homes can improve care. Outreach specialist services can be delivered without direct patient contact and achieve improvements in prescribing.
authors.affiliation: Flinders University Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia 5041, Australia. Maria.Crotty@flinders.edu.au
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
authors.forename: Julie
authors.initials: J
authors.lastname: Halbert
authors.forename: Debra
authors.initials: D
authors.lastname: Rowett
authors.forename: Lynne
authors.initials: L
authors.lastname: Giles
authors.forename: Robert
authors.initials: R
authors.lastname: Birks
authors.forename: Helena
authors.initials: H
authors.lastname: Williams
authors.forename: Craig
authors.initials: C
authors.lastname: Whitehead
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004358:Drug Therapy / Q000191:economics / Q000592:standards*; D017723:Drug Utilization Review; D005260:Female; D005500:Follow-Up Studies; D006302:Health Services Research; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009735:Nursing Homes / Q000592:standards*; D010348:Patient Care Team; D012044:Regression Analysis