title: Education to reduce potentially harmful medication use among residents of assisted living facilities: a randomized controlled trial.
abstract: OBJECTIVE
  The objectives of this study were (1) to investigate the effect of nurse training on the use of potentially harmful medications; and (2) to explore the effect of nurse training on residents' health-related quality of life (HRQoL), health service utilization, and mortality.
  
  
  METHODS
  A randomized controlled trial.
  
  
  METHODS
  In total, 227 residents in 20 wards of assisted living facilities in Helsinki were recruited. The 20 wards were randomized into those in which (1) staff received two 4-hour training sessions on appropriate medication treatment (intervention group), and (2) staff received no additional training and continued to provide routine care (control group).
  
  
  METHODS
  Two 4-hour interactive training sessions for nursing staff based on constructive learning theory to recognize potentially harmful medications and corresponding adverse drug events.
  
  
  METHODS
  Use of potentially harmful medications, HRQoL assessed using the 15 dimensional instrument of health-related quality of life, health service utilization, and mortality assessed at baseline, and 6 and 12 months.
  
  
  RESULTS
  During the 12-month follow-up, the mean number of potentially harmful medications decreased in the intervention wards [-0.43, 95% confidence interval (CI) -0.71 to -0.15] but remained constant in the control wards (+0.11, 95% CI -0.09 to +0.31) (P = .004, adjusted for age, sex, and comorbidities). HRQoL declined more slowly in the intervention wards (-0.038 (95% CI -0.054 to -0.022) than in the control wards (-0.072 (95% CI -0.089 to -0.055) (P = .005, adjusted for age, sex, and comorbidities). Residents of the intervention wards had significantly less hospital days (1.4 days/person/year, 95% CI 1.2-1.6) than in the control wards (2.3 days/person/year; 95% CI 2.1-2.7) (relative risk 0.60, 95% CI 0.49-0.75, P < .001, adjusted for age, sex, and comorbidities).
  
  
  CONCLUSIONS
  Activating learning methods directed at nurses in charge of comprehensive care can reduce the use of harmful medications, maintain HRQoL, and reduce hospitalization in residents of assisted living facilities.
authors.affiliation: Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Helsinki, Finland. Electronic address: kaisu.pitkala@helsinki.fi.
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkälä
authors.affiliation: Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Helsinki, Finland; City of Kouvola, Services for the Aged, Kouvola, Finland.
authors.forename: Anna-Liisa
authors.initials: AL
authors.lastname: Juola
authors.affiliation: Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Helsinki, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Social Services and Health Care Department, City of Helsinki, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Soini
authors.affiliation: Head of the Ageing and Services, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: U Harriet
authors.initials: UH
authors.lastname: Finne-Soveri
authors.affiliation: Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.affiliation: Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Helsinki, Finland; Geriatric Unit, Department of Internal Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Björkman
mesh_terms: D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D002423:Cause of Death; D005260:Female; D005387:Finland; D015577:Geriatric Assessment; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D007318:Inservice Training; D008297:Male; D009740:Nursing Staff / Q000193:education*; D019338:Polypharmacy; D011788:Quality of Life
keywords: Inappropriate drugs; anticholinergic drugs; assisted living; polypharmacy; psychotropic drugs; randomized controlled trial