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A systematic review of interventions to improve analgesic use and appropriateness in long-term care facilities

Dowd, LA, Cross, AJ, Veal, F ORCID: 0000-0001-9018-1965, Ooi, CE and Bell, JS 2021 , 'A systematic review of interventions to improve analgesic use and appropriateness in long-term care facilities' , Journal of The American Medical Directors Association , doi: https://doi.org/10.1016/j.jamda.2021.09.024.

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Abstract

Objectives: To systematically review the effectiveness of interventions to improve analgesic use and appropriateness in long-term care facilities (LTCFs).Design: Systematic review.Setting and participants: MEDLINE, Embase, PsycINFO, and CINAHL Plus were searched from inception to June 2021. Randomized controlled trials (RCTs), controlled and uncontrolled prospective interventions that included analgesic optimization, and reported postintervention change in analgesic use or appropriateness in LTCFs were included.Methods: Screening, data extraction, and quality assessment were performed independently by 2 review authors.Results: Eight cluster RCTs, 2 controlled, and 6 uncontrolled studies comprising 9056 residents across 9 countries were included. The 16 interventions included education (n = 13), decision support (n = 7), system modifications (n = 6), and/or medication review (n = 3). Six interventions changed analgesic use or appropriateness, all of which included prescribers, 5 involved multidisciplinary collaboration, and 5 included a component of education. Education alone changed analgesic use and appropriateness in 1 study. Decision support was effective when combined with education in 3 interventions. Overall, 13 studies reported analgesic optimization as part of pain management interventions and 3 studies focused on medication optimization. Two pain management interventions reduced the percentage of residents reporting pain not receiving analgesics by 50% to 60% (P = .03 and P Conclusions and implications: Interventions involving prescribers and enhanced roles for pharmacists and nurses, with a component of education, are most effective at changing analgesic use or appropriateness. Interventions combining education and decision support are also promising. Medication review interventions can change analgesic prescription, although there is currently minimal evidence in relation to possible corresponding improvements in resident-related outcomes.

Item Type: Article
Authors/Creators:Dowd, LA and Cross, AJ and Veal, F and Ooi, CE and Bell, JS
Keywords: long-term care, analgesics, opioids, pain, pain management
Journal or Publication Title: Journal of The American Medical Directors Association
Publisher: Lippincott Williams & Wilkins
ISSN: 1525-8610
DOI / ID Number: https://doi.org/10.1016/j.jamda.2021.09.024
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