Skip to main content

01.12.2019 | Research article | Ausgabe 1/2019 Open Access

BMC Geriatrics 1/2019

Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: results from the interventional study InTherAKT

BMC Geriatrics > Ausgabe 1/2019
Angelika Mahlknecht, Laura Krisch, Nadja Nestler, Ulrike Bauer, Nina Letz, Daniel Zenz, Jochen Schuler, Laura Fährmann, Georg Hempel, Maria Flamm, Jürgen Osterbrink
Wichtige Hinweise

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



Uncoordinated interprofessional communication in nursing homes increases the risk of polypharmacy and inappropriate medication use. This may lead to augmented frequency of adverse drug events, hospitalizations and mortality. The aims of this study were (1) to improve interprofessional communication and medication safety using a combined intervention and thus, (2) to improve medication appropriateness and health-related outcomes of the included residents.


The single-arm interventional study (2014–2017) was conducted in Muenster, Germany and involved healthcare professionals and residents of nursing homes.
The intervention consisted of systematic education of participating healthcare professionals and of a structured interprofessional medication review which was performed via an online communication platform.
The primary endpoint was assessed using the Medication Appropriateness Index MAI. Secondary endpoints were: cognitive performance, delirium, agitation, mobility, number of drugs, number of severe drug-drug interactions and appropriateness of analgesics.
Outcomes were measured before, during and after the intervention. Data were analyzed using descriptive and inference-statistical methods.


Fourteen general practitioners, 11 pharmacists, 9 nursing homes and 120 residents (n = 83 at all testing times) participated.
Overall MAI sum-score decreased significantly over time (mean reduction: -7.1, CI95% -11.4 – − 2.8; median = − 3.0; dCohen = 0.39), especially in cases with baseline sum-score ≥ 24 points (mean reduction: -17.4, CI95% -27.6 – − 7.2; median = − 15.0; dCohen = 0.86).
MAI sum-score of analgesics also decreased (dCohen = 0.45). Mean number of severe drug-drug interactions rose slightly over time (dCohen = 0.17). The proportion of residents showing agitated behavior diminished from 83.9 to 67.8%. Remaining secondary outcomes were without substantial change.


Medication appropriateness increased particularly in residents with high baseline MAI sum-scores. Cognitive decline of participating residents was seemingly decelerated when compared with epidemiologic studies. A controlled trial is required to confirm these effects. Interprofessional interaction was structured and performance of medication reviews was facilitated as the online communication platform provided unlimited and consistent access to all relevant and updated information.

Trial registration

DRKS Data Management, ID: DRKS00007900, date of registration: 2015-09-02 (retrospectively registered i.e. 6 weeks after commencement of the first data collection).
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2019

BMC Geriatrics 1/2019 Zur Ausgabe

Neu im Fachgebiet Innere Medizin

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Innere Medizin und bleiben Sie gut informiert – ganz bequem per eMail.

© Springer Medizin