The Steps SNFs Can Take to Reduce Inappropriate Medication Use

Skilled nursing facilities looking to lower the use of potentially inappropriate medications (PIMs) could see success through implementing Multidisciplinary Multistep Medication Review (3MR) intervention, a study published Oct. 10 in the Annals of Internal Medicine suggests.

Hans Wouters of the University Medical Center Groningen in the Netherlands, along with his colleagues, recruited 426 nursing home residents from 59 Dutch nursing home wards, randomly assigning them to either a control group or the 3MR intervention.

The 3MR consisted of an evaluation of the patient’s perspective, a medical history, a medication appraisal, a meeting between the pharmacist and the treating physician, and changes in medication strategy.


The patients were followed for an average of 144 days and assessed after four months.

In the intervention group, 39.1% of participants discontinued use of at least one inappropriate medication, compared with 29.5% in the control group. In addition, there was no decline in clinical outcomes compared, indicating that intervention could be helpful for reducing inappropriate prescription use without a negative clinical effect on nursing home residents.

The Netherlands Organization for Health Research and Development was the primary funder of the study.


Despite the Dutch setting, the findings could have significant impact for skilled nursing facilities (SNFs) stateside, given ongoing efforts by the Centers for Medicare & Medicaid Services (CMS) to reduce unnecessary drug use. For instance, CMS set a five-year goal of cutting antipsychotic drug use in long-term care facilities by 30% through 2016; a recent study showed that the industry beat that goal, reducing antipsychotic prescriptions by 34.1%.

But the news isn’t all good, and the Dutch study could provide a road map for future improvements.

“Despite efforts to reduce potentially inappropriate medication use, prescribing quality has worsened in the nursing home setting,” wrote Holly Holmes of University of Texas and Greg Sachs of Indiana University in an accompanying editorial.  

“Twenty-seven percent to 71% of nursing home residents use at least one PIM, and PIM use is associated with increased risk for falls, delirium, and cognitive impairment,” Holmes and Sachs wrote. “Medication use is particularly risky in nursing homes given that they have a frail population with a high prevalence of dementia and multimorbidity.”

Written by Maggie Flynn

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