Conclusions
agitation, dementia
This pragmatic, controlled study tested the effects of an interdisciplinary intervention comprising KE and medication review guidance for NH residents with severe dementia. While overall reduction of medication load was observed in both the control and the intervention NH, general practice improvement strategies aimed at all pharmacists and physicians working in the greater health network, and possibly a ceiling effect on the reduction of mean daily medications, likely contributed to this result. However, the interactions with pharmacists, nurses, and physicians during the KE sessions in this study confirmed that there is an ongoing need for education of clinicians on the considerations regarding medication appropriateness among NH residents with severe dementia. Guidance specific to these NH residents may still contribute to improved medication use among this particularly vulnerable population.To counter the limitations of this pragmatic controlled study, a large, multi-site, cluster randomized trial is planned to evaluate the effects of the OptimaMed-LTC intervention, i.e. a KE session on medication appropriateness, medication adjustment and deprescribing in NH residents with severe dementia, based on validated and updated criteria on appropriateness in these particularly vulnerable residents. Moreover, the expanded roles of pharmacists already observed in several countries, including Canada, increasingly allow pharmacists to adjust medication dosage, including reduction to zero. Pharmacists may also prescribe some medications, i.e. use restricted prescribing privileges. Future studies should assess the effects of NH pharmacists’ medication review, adjustment and deprescribing on residents’ quality of life, agitation, and discomfort, particularly among those who are very frail or have severe dementia.