Inappropriate prescribing is a well-known clinical problem in nursing home residents, but few interventions have focused on reducing inappropriate medication use.

To examine successful discontinuation of inappropriate medication use and to improve prescribing in nursing home residents.

Pragmatic cluster randomized controlled trial, with clustering by elder care physicians and their wards. (ClinicalTrials.gov: NCT01876095)

59 Dutch nursing home wards for long-term care.

Residents with a life expectancy greater than 4 weeks who consented to treatment with medication.

Multidisciplinary Multistep Medication Review (3MR) consisting of an assessment of the patient perspective, medical history, critical appraisal of medications, a meeting between the treating elder care physician and the pharmacist, and implementation of medication changes.

Successful discontinuation of use of at least 1 inappropriate drug (that is, without relapse or severe withdrawal symptoms) and clinical outcomes (neuropsychiatric symptoms, cognitive function, and quality of life) after 4 months of follow-up.

Nineteen elder care physicians (33 wards) performed the 3MR, and 16 elder care physicians (26 wards) followed standard procedures. A total of 426 nursing home residents (233 in the intervention group and 193 in the control group) were followed for an average of 144 days (SD, 21). In an analysis of all participants, use of at least 1 inappropriate medication was successfully discontinued for 91 (39.1%) residents in the intervention group versus 57 (29.5%) in the control group (adjusted relative risk, 1.37 [95% CI, 1.02 to 1.75]). Clinical outcomes did not deteriorate between baseline and follow-up.

The 3MR was done only once. Some withdrawal symptoms or relapses may have been missed.

The 3MR is effective in discontinuing inappropriate medication use in frail nursing home residents without a decline in their well-being.

Netherlands Organisation for Health Research and Development.

不适当的处方是疗养院居民的一个众所周知的临床问题，但很少有干预措施专注于减少不适当的药物使用。

检查成功停止不适当的药物使用并改善疗养院居民的处方。

务实的集群随机对照试验，由老年护理医师及其病房进行集群。（ClinicalTrials.gov：NCT01876095）

59 个荷兰疗养院病房提供长期护理。

预期寿命超过 4 周且同意接受药物治疗的居民。

多学科多步骤药物审查 (3MR) 包括对患者观点的评估、病史、药物的严格评估、治疗老年护理医师和药剂师之间的会议以及药物变化的实施。

随访 4 个月后，成功停止使用至少 1 种不适当药物（即没有复发或严重的戒断症状）和临床结果（神经精神症状、认知功能和生活质量）。

19 名老年护理医师（33 个病房）执行了 3MR，16 名老年护理医师（26 个病房）遵循标准程序。共有 426 名疗养院居民（干预组 233 人，对照组 193 人）平均随访 144 天（SD，21）。在对所有参与者的分析中，干预组有 91 名 (39.1%) 居民成功停止使用至少一种不适当的药物，而对照组有 57 名 (29.5%) 居民（调整后的相对风险，1.37 [95% CI，1.02至 1.75]）。基线和随访之间的临床结果没有恶化。

3MR ​​只进行了一次。可能遗漏了一些戒断症状或复发。

3MR ​​可有效停止虚弱的疗养院居民不适当的药物使用，而不会降低他们的幸福感。

荷兰卫生研究与发展组织。