DemAsCH Study: Improving the quality of prescriptions in nursing homes

On January 10, 2020, a meeting was held to present the results of the DemAsCH study (Unmask anticholinergics) by the Korian Foundation for Ageing Well.

This study on the prevention of drug-induced iatrogenicity carried out in Korian nursing homes was launched in October 2017.

Présentation DEMASCH

Supported by the Association du « Bon Usage du Médicament », in collaboration with the Vidal group, the company Medissimo and the research team of the Gerontopole "Ageing well in Champagne-Ardenne", the objective of the DemAsCH study was to evaluate the impact of a collaborative therapeutic optimization program in nursing homes on the rate of potentially inappropriate prescriptions of anticholinergics.

 

"This study follows on from the analysis we conducted in 2015 in collaboration with Vidal and Medissimo of one million prescription lines concerning 14,000 patients in 110 Korian nursing homes. This showed a frequent use of drugs with anticholinergic properties when they present risks of peripheral or central side effects with a negative impact on the health of the elderly" says Aude Letty, General Delegate of the Korian Foundation for Ageing Well. 

 

Anticholinergic drugs most often cause many side effects: confusion, disorientation, urinary retention, constipation... Several drugs have been identified for their "masked" anticholinergic properties within several classes: anxiolytics, antipsychotics, antidepressants, antihistamines...

  

Slides 2 Demasch

In the elderly, they trigger or emphasize existing disorders, which are more sensitive to the cumulative effect of the combination of several drugs with anticholinergic properties.

 

study methodology

The DemAsCH study was carried out in 33 Korian homes, over a period of 18 months:

  • Firstly 10 intervention facilities in which tools for identifying anticholinergic drugs and proposing alternatives have been set up. The coordinating doctors also received monthly indicators of the prescription of these anticholinergic drugs on the site (percentage of residents on anticholinergic drugs, number of anticholinergic drugs prescribed, number of prescriptions, etc.) They also received aggregate data from all institutions, allowing them to compare their indicators to the average of the intervention and control groups. They were thus able to manage their communication actions with prescribing doctors and pharmacists. 
  • On the other side, 23 witness institutions (no communication or particular action).

 

In addition to the statistical analysis of the study data, two focus groups were carried out with coordinating doctors to gather their opinions on the experience, the relevance of the campaign and the interest of the dialogue initiated on this issue with the referring doctors.

 

"I want to emphasize the relevant method used in this study, respectful of prescribing doctors. Our coordinating doctors have positioned themselves as partners to help them detect "masked" anticholinergics. A successful dialogue took place between them" underlines Paul-Emile Haÿ, medical and care director of Korian France Seniors

 

tools developed

  • An awareness-raising brochure on anticholinergics (reminders of side effects, warning signals to watch out for, list of molecules targeted for study...) 
  • The Korian booklet "Livret Korian sur le bon usage du médicament" for a good use on the elderly person.
  • An IT tool to identify anticholinergic drugs with a proposal for therapeutic alternatives (reference to the Korian Drug Bookled)
  • Awareness posters

Slide outils Demasch

 

the results of the study

  • The study resulted in a significant 14% decrease in anticholinergic drug prescriptions in the intervention group compared to the control group.
  • It thus avoided potentially inappropriate prescriptions in 3 out of 100 residents
  • By applying this method to all nursing homes in France, more than 20,000 residents could no longer be exposed to potentially inappropriate anticholinergic drugs.

 

The qualitative part of the study highlighted the acceptance of the approach by all doctors and pharmacists, a strengthened interprofessional dialogue and better vigilance.

The coordinating doctors acted as true conductors and partners to help prescribing physicians detect « masked » anticholinergics. A very beneficial dialogue was established between them and this respectful method was praised.

 

DemAsCH not only highlighted convincing quantitative results (14% decrease in PIP in the intervention group) but above all showed the strength of the dialogue between professionals to improve the « Good Drug Use ».