Despite efforts to reduce potentially inappropriate medication (PIM) use, prescribing quality has worsened in the nursing home setting. Twenty-seven percent to 71% of nursing home residents use at least 1 PIM, and PIM use is associated with increased risk for falls, delirium, and cognitive impairment (1). Medication use is particularly risky in nursing homes given that they have a frail population with a high prevalence of dementia and multimorbidity.
In this issue, Wouters and colleagues report the results of a deprescribing study targeting PIM use in nursing homes (2). In this cluster randomized trial, 426 nursing home residents recruited from 59 Dutch nursing home wards were randomly assigned to an intervention to reduce PIM use or to usual care. The intervention, the Multidisciplinary Multistep Medication Review (3MR), was performed once, with an evaluation 4 months later, and had 4 components: assessment of the patient's perspective and a comprehensive medical and medication review, identification of medications to stop on the basis of the STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) and Beers criteria, a meeting between the pharmacist and the physician, and implementation of medication changes based on an agreed-upon plan. Usual care included a pharmacist review mandated in Dutch nursing home wards. The primary outcome was discontinuation of use of at least 1 PIM at 4 months, and secondary outcomes included neuropsychiatric symptoms, cognitive function, and quality of life. More patients discontinued use of at least 1 PIM in the intervention group than the control group (39.1% vs. 29.5%; adjusted relative risk, 1.37 [95% CI, 1.02 to 1.75]). There was no between-group difference in adverse events or secondary outcomes. The authors powered the study for reductions in PIM use of 40% in the intervention group and 20% in the usual care group. They concluded that the 3MR resulted in favorable outcomes without adversely affecting patients.