title: An evaluation of an adapted U.S. model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in northern ireland (fleetwood northern ireland study).
abstract: OBJECTIVE
  To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI).
  
  
  METHODS
  Cluster randomized controlled trial.
  
  
  METHODS
  Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).
  
  
  METHODS
  Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control).
  
  
  METHODS
  Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care.
  
  
  METHODS
  The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI.
  
  
  RESULTS
  The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14-0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups.
  
  
  CONCLUSIONS
  Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.
authors.affiliation: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Patterson
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hughes
authors.forename: Grainne
authors.initials: G
authors.lastname: Crealey
authors.forename: Chris
authors.initials: C
authors.lastname: Cardwell
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009660:Northern Ireland; D009735:Nursing Homes; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D016037:Single-Blind Method; D014481:United States
chemical_list: D011619:Psychotropic Drugs