Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 May;19(5):1865-1875.
doi: 10.1002/alz.12808. Epub 2022 Nov 4.

Effect of collaborative dementia care on potentially inappropriate medication use: Outcomes from the Care Ecosystem randomized clinical trial

Amy K Liu  1   2 , Katherine L Possin  2   3 , Kristen M Cook  4 , Shalini Lynch  1 , Sarah Dulaney  2 , Jennifer J Merrilees  2 , Tamara Braley  5 , Rachel E Kiekhofer  2 , Stephen J Bonasera  5 , Isabel E Allen  6 , Winston Chiong  2 , Amy M Clark  5 , Julie Feuer  2 , Joan Ewalt  5 , Elan L Guterman  2   7 , Rosalie Gearhart  2 , Bruce L Miller  2 , Kirby P Lee  1
Affiliations
Randomized Controlled Trial

Effect of collaborative dementia care on potentially inappropriate medication use: Outcomes from the Care Ecosystem randomized clinical trial

Amy K Liu et al. Alzheimers Dement. 2023 May.

Abstract

Introduction: Potentially inappropriate medications (PIMs) cause adverse events and death. We evaluate the Care Ecosystem (CE) collaborative dementia care program on medication use among community-dwelling persons living with dementia (PLWD).

Methods: Secondary analysis of a randomized clinical trial (RCT) comparing CE to usual care (UC) on changes in PIMs, over 12 months between March 2015 and May 2020. Secondary outcomes included change in number of medications, clinically relevant PIMs, and anti-dementia medications.

Results: Of 804 PLWD, N = 490 had complete medication data. The CE resulted in significantly fewer PIMs compared to UC (-0.35; 95% CI, -0.49 to -0.20; P < 0.0001). Number needed to prevent an increase in 1 PIM was 3. Total medications, PIMs for dementia or cognitive impairment, CNS-active PIMs, anticholinergics, benzodiazepines, and opioids were also fewer. Anti-dementia medication regimens were modified more frequently.

Conclusion: The CE medication review intervention embedded in collaborative dementia care optimized medication use among PLWD.

Highlights: Compared to usual care (UC), the Care Ecosystem (CE) medication review intervention prevented increases in potentially inappropriate medications (PIMs). Use of anticholinergics, benzodiazepines, and opioids were significantly reduced, with a trend for antipsychotics. Anti-dementia medications were adjusted more frequently. The CE medication review intervention embedded in collaborative dementia care optimized medication use.

Trial registration: ClinicalTrials.gov NCT02213458.

Keywords: anti-dementia medications; dementia; medication review; pharmacist; polypharmacy; potentially inappropriate medications.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures:

Dr. Liu reported receiving grant funding from the National Institute of General Medicine Sciences (T32GM007546).

Dr. Possin reported receiving grants from the National Institute of Neurological Disorders and Stroke, the National Institute on Aging, Global Brain Health Institute, Quest Diagnostics, Administration for Community Living, Rainwater Charitable Trust, and Merck Foundation; and personal fees from ClearView Health Partners and Vanguard.

Dr. Chiong reported receiving grants from the National Institute on Mental Health and the National Institute on Aging.

Dr. Guterman reported receiving grant funding from the National Institute of Neurological Disorders and Stroke (1K23NS116128-01), National Institute on Aging (5R01AG056715), and American Academy of Neurology. She has received personal compensation from Marinus Pharmaceuticals, Inc., JAMA Neurology, and Remo Health, which are unrelated the submitted work.

Figures

Figure 1.
Figure 1.
CONSORT Flow Diagram
Figure 2.
Figure 2.
The Care Ecosystem Medication Review Intervention and Monitoring Process
Figure 3.
Figure 3.
Flowchart of the Care Ecosystem Medication Review Intervention and Monitoring Process
See this image and copyright information in PMC

References

    1. Maust DT, Kim HM, Seyfried LS, Chiang C, Kavanagh J, Schneider LS, et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry. 2015;72(5):438–45. - PMC - PubMed
    1. Barry HE, Cooper JA, Ryan C, Passmore AP, Robinson AL, Molloy GJ, et al. Potentially Inappropriate Prescribing Among People with Dementia in Primary Care: A Retrospective Cross-Sectional Study Using the Enhanced Prescribing Database. J Alzheimers Dis. 2016;52(4):1503–13. - PubMed
    1. Hukins D, Macleod U, Boland JW. Identifying potentially inappropriate prescribing in older people with dementia: a systematic review. Eur J Clin Pharmacol. 2019;75(4):467–81. - PubMed
    1. Murphy C, Dyer AH, Lawlor B, Kennelly SP, Group NS. Potentially inappropriate medication use in older adults with mild-moderate Alzheimer’s disease: prevalence and associations with adverse events. Age Ageing. 2020;49(4):580–7. - PubMed
    1. Delgado J, Bowman K, Clare L. Potentially inappropriate prescribing in dementia: a state-of-the-art review since 2007. BMJ Open. 2020;10(1):e029172. - PMC - PubMed

Publication types

Associated data