To what extent is clinical and laboratory information used to perform medication reviews in the nursing home setting? the CLEAR study

Figures & data

Figure 1 Study and design.

Notes: Stage 1, with medication list only; stage 2 all information (medication list, reason for hospital admission, and laboratory values) except drug indication and/or medical history; stage 3 complete case (medication list, reason for hospital admission, laboratory values, drug indication, and/or medical history).
Abbreviations: P, participants; E, expert team.

Figure 2 Participation and dropout rates.

Abbreviations: PH, pharmacists; NH, nursing home physicians; GP, general practitioners.

Table 1 Demographic characteristics of the participants

PH 15 participants	5 (33.3%) males
	10 (66.6%) females
	With an average of 17.2 years experience
NH 18 articipants	6 (33.3%) male
	12 (66.6%) female
	With an average of 13.4 years experience
GP 13 participants	7 (53.8%) male
	6 (46.2%) female
	With an average of 20.9 years experience

Abbreviations: PH, pharmacists; NH, nursing home physicians; GP, general practitioners.

Table 2 Estimated mean percentage ± standard error for cases A, B, and C, differentiated by group and stage

Group	Case A			Case B			Case C
	Stage 1	Stage 2	Stage 3	Stage 1	Stage 2	Stage 3	Stage 1	Stage 2	Stage 3
All	40.0±2.3*	30.9±3.6*	27.9±3.2*	38.0±3.8	35.2±3.7	36.4±3.1	41.4±2.6	40.3±3.2	42.7±3.2
PH	38.7±4.0	40.1±6.2#	30.2±5.9	42.5±6.6	42.1±6.7	40.9±5.7	42.2±4.6	41.0±6.0	39.6±6.0
NH	37.1±3.6‡	20.1±5.4‡,#	21.9±5.0‡	29.9±6.1	29.1±5.9	33.1±4.8	40.7±4.2	45.1±5.2	42.1±5.0
GP	45.6±4.2	36.3±6.4	33.8±5.9	44.2±7.1	36.5±6.6	36.0±5.7	41.5±5.0	33.9±5.7‡	46.9±6.0‡

Notes:

* Statistically significant for case A, the overall mean percentage significantly decreased over the stages (P=0.001). The mean differences decreased between stages 1 and 2 (−9.1, 95% CI −15.3, −3.0, P=0.005), and between stages 1 and 3 (−12.1, 95% CI −18.6, −5.6, P<0.001).

‡ Statistically significant within-group effect over the different stages found for case A from stage 1 to stage 2 (P=0.001), and from stage 1 to stage 3 (P=0.005) in group 2 (NH), and for case C from stage 2 to stage 3 (P=0.037) in group 3 (GP).

# Statistically significant between-group effects for case A at stage 2, ie, the estimated mean percentage was significantly lower in group 2 (NH; 20.1%) than in group 1 (PH; 40.1%, P=0.019).

Abbreviations: CI, confidence interval; PH, pharmacists; NH, nursing home physicians; GP, general practitioners.

Medication

Aspirin 80 mg once daily

Bumetanide 1 mg once daily

Esomeprazole 40 mg once daily

Iron 200 mg three times daily

Metoprolol Retard 50 mg once daily

Isosorbide mononitrate, extended release 25 mg once daily

Potassium chloride 600 mg three times daily

Methimazole 10 mg once daily

Thiamine 50 mg once daily

Oxazepam 10 mg four times daily

Duratears^® eye drops as needed

Vitamin B12 injection once a month

GaviLAX GlycoLax Miralax once daily

Metoclopramide 20 mg suppository as needed

Laboratory investigations

Description	Units	Reference range	14:34	14:39
Routine hematology (EDTA)
Erythrocyte sedimentation rate	mm	0–19	9
Hemoglobin	mmol/L	7.3–9.7	7.8
MCV	fL	80–100	91
Platelets	10^9/L	130–350	328
Leukocytes	10^9/L	3.5–11.0	6.3
Routine hematology (differentiation)
Neutrophils	%	40–70	82 H
Lymphocytes	%	15–48	13 L
Monocytes	%	4–11	4
Eosinophils	%	0–10	1
Basophils	%	0–2	0
LKC (serum chemistry)
Sodium	mmol/L	135–145		132 L
Potassium	mmol/L	3.60–5.00		3.85
Urea	mmol/L	3.0–8.0		3.1
Creatinine	μmol/L	50–100		66
MDRD-eGFR	mL/min/1.73 m^2	<60		<60.0
NT-proBNP	pmol/L	<35		573 H
LKC hormones
Unbound T4	pmol/L	8.0–18.0		11.2
TSH	mU/L	0.40–3.50		6.9 H
LKC vitamins
Vitamin B12	pmol/L	250–850		980 H

Note: 14:34 and 14:39 is the time when the blood was analyzed.

Abbreviations: EDTA, ethylenediaminetetraacetic acid; TSH, thyroid-stimulating hormone; MCV, mean cell volume; MDRD, Modification of Diet in Renal Disease; eGFR, estimated glomerular filtration rate; NT-proBNP, N-terminal pro-brain natriuretic peptide; LKC, Laboratorium Klinische Chemie.

Medication

Levodopa/carbidopa (levodopa and decarboxylase inhibitor) prescribed by a neurologist

Allopurinol 100 mg three times daily

Esomeprazole 40 mg once daily

Solifenacin 5 mg once daily

Haloperidol 1 mg once daily if needed

Furosemide 40 mg once daily

GaviLAX GlycoLax Miralax once daily

Valsartan 80 mg once daily

Laboratory investigations

Description	Units	Reference range	April 3, 2011		June 15, 2011	June 29, 2011
			14:28	14:39	14:03	15:49
Routine hematology (EDTA)
Hemoglobin	mmol/L	7.3–9.7		8.1
Hematocrit	L/L	0.36–0.48		0.38
MCV	fL	80–100		93
LKC (serum chemistry)
Sodium	mmol/L	135–145	130 L		122 L
Potassium	mmol/L	3.60–5.00	4.21		5.13 H
Urea	mmol/L	3.0–8.0	5.9		6.4
Creatinine	μmol/L	50–100	76		104
MDRD-eGFR	mL/min/1.73 m^2	<60	<60.0		45 L
LKC (hormones)
TSH	mU/L	0.40–3.50				0.6
LKC (vitamins)
Vitamin B1	nmol/L	100–230				161
Vitamin B6	nmol/L	50–200				537 H
Vitamin B12	pmol/L	250–850				214 L
Folic acid	nmol/L	3–20				<45.0 H

Note: 14:28, 14:39, 14:03 and 15:49 is the time when the blood was analyzed.

Abbreviations: EDTA, ethylenediaminetetraacetic acid; TSH, thyroid-stimulating hormone; MCV, mean cell volume; MDRD, Modification of Diet in Renal Disease; eGFR, estimated glomerular filtration rate; LKC, Laboratorium Klinische Chemie.

Medication

Acetylsalicylic acid 80 mg once daily

Alendronate 70 mg once weekly

Bumetanide 1 mg once daily

Isosorbide mononitrate Retard 50 mg once daily Metoprolol 100 mg once daily

Simvastatin 40 mg once daily

Calcium/vitamin D 1,000 mg/880 IU once daily

Oxynorm 10 mg, 10 pm, once daily

Oxycontin 5 mg as needed

Duratears^® eye drops as needed

Esomeprazole 20 mg once daily if needed

Metoclopramide 10 mg as needed

Ibuprofen 600 mg three times daily

Miconazole cream as needed

Temazepam 10 mg twice daily

Amoxicillin/clavulanic acid 500/125 mg three times daily

Laboratory values

Description	Units	Reference range	June 7, 2011
			14:34	14:39
Routine hematology (EDTA)
Sedimentation	mm	0–19	43 H
Leucocytes	10E^9/L	3.5–11.0	6.6
LKC serum chemistry
Glucose	mmol/L	3.6–6.1		18 H
Urea	mmol/L	3.0–8.0		9.7 H
Creatinine	μmol/L	50–100		160 H
MDRD-eGFR	mL/min/1.73 m^2	<60		26 L
CRP	mg/L	<10		9
Folic acid	nmol/L	3–20		<45.0 H

Note: 14:34 and 14:39 is the time when the blood was analyzed.

Abbreviations: CRP, C-reactive protein; EDTA, ethylenediaminetetraacetic acid; MDRD, Modification of Diet in Renal Disease; eGFR, estimated glomerular filtration rate; LKC, Laboratorium Klinische Chemie.