Medication Appropriateness Tool for Comorbid Health conditions during Dementia

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The Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria supports clinicians to manage medication use specifically for people with dementia without focusing only on the management of the dementia itself. [1] [2]

Contents

History

The MATCH-D were developed by medical practitioners and pharmacists at Australian Group of Eight Universities. It was led by Dr Amy Theresa Page at the Western Australian Centre for Health and Ageing at the University of Western Australia. The MATCH-D Criteria were developed through a consensus panel of experts using the Delphi method. The criteria were originally published in the Internal Medicine Journal in 2016. [2] The protocol explaining the rigorous methods used to develop the criteria were originally published in the BMJ Open in 2015. [3] The systematic review that informed the criteria were published subsequently in 2018 and updated in 2022. [4] [5]

Style of the criteria

The MATCH-D is presented in categories of recommendations for all stages of dementia, as well as divided into specific recommendations for early, mid and late-stage dementia. [6] The recommendations are groups as: medication side effects, principles for medication use, medication review, treatment goals, preventative medications, symptom management, psycho-active medications and medications to modify dementia progression.

Reception of the criteria

The MATCH-D attracted media attention as it was under development, and as it was released. Page was interviewed on the ABC national radio's science show during its development. [7] The health media picked up the story as soon as it was published. [8]

Organisations who recommend the criteria

Respected organisations such as the British Geriatrics Society incorporated into their own medicines management guidelines. In New Zealand, the NZ Health Quality & Safety Commission have shared it in their communications. [9]

It is cited and promoted by influential professional bodies in many countries including:

- the British Geriatrics Society's End of Life Care in Frailty guidelines [10]

- New Zealand's Health Quality & Safety Commission's medication management work [11] [12]

- Australia's Royal Australian College of General Practitioners (RACGP) aged care clinical guide known as the Silver Book [13]

- Australia's Pharmaceutical Society of Australia (PSA) Choosing Wisely series

- Australian Commission on Safety and Quality in Health Care [14]

- Australian Deprescribing Network (ADeN)

- Australia's NPS MedicinesWise recommended it in their Medication Management Review Reports: Best practice recommendations program and Changed Behaviour in Dementia. [15] [16]

- New South Wales' Therapeutic Advisory Group (TAG)

Uses

Consumers considered the MATCH-D to be a useful tool for prompting and supporting conversations about their preferences for medication use. They would prefer that these conversations began as early as possible so that their treating health professionals knew their preferences. General practitioners, pharmacists and nurses stated they often felt less comfortable discussing these issues as they were concerned that it may cause distress to the consumer. Health professionals and consumers alike thought that using the MATCH-D as a conversation starter could assist with these conversations. [17]

It is incorporated in to the TaperMD decision support tool and the PIMSPlus platform. This incorporation has hastened the uptake of the criteria in both long term care facilities and community in Canada.

More than one-quarter of Australian consultant pharmacists state that they use the MATCH-D during Home Medicine Reviews. [18] This figure is suggestive of high uptake given that most Home Medicine Reviews are most likely undertaken for people who are not living with dementia.

Research on the criteria

Translational research was undertaken with consumers, general practitioners, nurses and pharmacists to explore the enablers and barriers to using the MATCH-D in practice. [17] This research showed the need for a website (since launched at MATCH-D.com.au), checklists (available at the website) and educational resources. These stakeholder roles have shown that there is a strong need for support and collaboration to improve medication use. [19]

Research at King's College London explored the hazards of suboptimal prescribing and polypharmacy in medicines use for people with dementia. They determined that each year there are globally up to 10 million people living with dementia require hospital treatment (emergency department or hospital admissions) related to medicines related harm for people with dementia. [20] They concluded that, if the MATCH-D were successfully implemented that the relative hazards of medicines use for people with dementia would need to be re-evaluated.

The National Health and Medical Research Council (NHMRC) are currently funding a randomised controlled trial implementing the MATCH-D using pharmacists embedded in general practice. [21]

Educational resources

The Dementia Training Australia funding an interactive online education package for deprescribing in dementia centered around the MATCH-D. It was a joint collaboration between the University of Western Australia, University of Tasmania, La Trobe University, Monash University, Alfred Health and FireFilms. This education package launched in mid-2019. [22] This online course is suitable for consumers and health professionals, with a target audience of nurses working in residential aged care facilities. The training package was in the format of a documentary film, with its original developer, Dr Page featured as narrator and interviewer. It includes simulated patient encounters and expert interviews, interspersed with interactive activities.

The MATCH-D and the training package by Dementia Training Australia have now been incorporated into undergraduate degrees for health professionals including the University of Tasmania's second year Bachelor of Nursing curriculum and Monash University's Bachelor of Pharmacy (Honours) curriculum.

Related Research Articles

<span class="mw-page-title-main">Dementia</span> Long-term brain disorders causing impaired memory, thinking and behavior

Dementia is the general name for a decline in cognitive abilities that impacts a person's ability to perform everyday activities. This typically involves problems with memory, thinking, and behavior. Aside from memory impairment and a disruption in thought patterns, the most common symptoms include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Dementia ultimately has a significant effect on the individual, caregivers, and on social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than what is caused by normal aging.

<span class="mw-page-title-main">Pharmacist</span> Healthcare professional

A pharmacist is a healthcare professional who specializes in the preparation, dispensing, and management of medications and who provides pharmaceutical advice and guidance. Pharmacists often serve as primary care providers in the community, and may offer other services such as health screenings and immunizations.

Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome, is the group of symptoms that occur upon the abrupt discontinuation or decrease in the intake of pharmaceutical or recreational drugs.

<span class="mw-page-title-main">Geriatrics</span> Specialty that focuses on health care of elderly people

Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of the elderly. The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.

The Pharmaceutical Benefits Scheme (PBS) is a program of the Australian Government that subsidises prescription medication for Australian citizens and permanent residents, as well as international visitors covered by a reciprocal health care agreement. The PBS is separate to the Medicare Benefits Schedule, a list of health care services that can be claimed under Medicare, Australia's universal health care insurance scheme.

<span class="mw-page-title-main">Polypharmacy</span> Use of five or more medications daily

Polypharmacy (polypragmasia) is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. The term polypharmacy is often defined as regularly taking five or more medicines but there is no standard definition and the term has also been used in the context of when a person is prescribed 2 or more medications at the same time. Polypharmacy may be the consequence of having multiple long-term conditions, also known as multimorbidity and is more common in people who are older. In some cases, an excessive number of medications at the same time is worrisome, especially for people who are older with many chronic health conditions, because this increases the risk of an adverse event in that population. In many cases, polypharmacy cannot be avoided, but 'appropriate polypharmacy' practices are encouraged to decrease the risk of adverse effects. Appropriate polypharmacy is defined as the practice of prescribing for a person who has multiple conditions or complex health needs by ensuring that medications prescribed are optimized and follow 'best evidence' practices.

<span class="mw-page-title-main">Adverse drug reaction</span> Harmful, unintended result of medication

An adverse drug reaction (ADR) is a harmful, unintended result caused by taking medication. ADRs may occur following a single dose or prolonged administration of a drug or may result from the combination of two or more drugs. The meaning of this term differs from the term "side effect" because side effects can be beneficial as well as detrimental. The study of ADRs is the concern of the field known as pharmacovigilance. An adverse event (AE) refers to any unexpected and inappropriate occurrence at the time a drug is used, whether or not the event is associated with the administration of the drug. An ADR is a special type of AE in which a causative relationship can be shown. ADRs are only one type of medication-related harm. Another type of medication-related harm type includes not taking prescribed medications, known as non-adherence. Non-adherence to medications can lead to death and other negative outcomes. Adverse drug reactions require the use of a medication.

An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complication is similar to adverse effect, but the latter is typically used in pharmacological contexts, or when the negative effect is expected or common. If the negative effect results from an unsuitable or incorrect dosage or procedure, this is called a medical error and not an adverse effect. Adverse effects are sometimes referred to as "iatrogenic" because they are generated by a physician/treatment. Some adverse effects occur only when starting, increasing or discontinuing a treatment. Using a drug or other medical intervention which is contraindicated may increase the risk of adverse effects. Adverse effects may cause complications of a disease or procedure and negatively affect its prognosis. They may also lead to non-compliance with a treatment regimen. Adverse effects of medical treatment resulted in 142,000 deaths in 2013 up from 94,000 deaths in 1990 globally.

A consultant pharmacist is a pharmacist who works as a consultant providing expert advice on clinical pharmacy, academic pharmacy or practice, public health pharmacy, industrial pharmacy, community pharmacy or practice, pharmaceutical analysis etc., regarding the safe use and production of medications or on the provision of pharmaceutical services to medical institutions, hospitals, universities, research institutions, medical practices and individual patients.

Medication discontinuation is the ceasing of a medication treatment for a patient by either the clinician or the patient themself. When initiated by the clinician, it is known as deprescribing. Medication discontinuation is an important medical practice that may be motivated by a number of reasons:

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, are guidelines published by the American Geriatrics Society (AGS) for healthcare professionals to help improve the safety of prescribing medications for adults 65 years and older in all except palliative settings. They emphasize deprescribing medications that are unnecessary, which helps to reduce the problems of polypharmacy, drug interactions, and adverse drug reactions, thereby improving the risk–benefit ratio of medication regimens in at-risk people.

Multimorbidity, also known as multiple long-term conditions (MLTC), means living with two or more chronic illnesses. For example, a person could have diabetes, heart disease and depression at the same time. Multimorbidity can have a significant impact on people's health and wellbeing. It also poses a complex challenge to healthcare systems which are traditionally focused on individual diseases. Multiple long-term conditions can affect people of any age, but they are more common in older age, affecting more than half of people over 65 years old.

<span class="mw-page-title-main">Clinical pharmacy</span> Branch of pharmacy for direct provision

Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, physician assistants, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.

Prescription cascade is the process whereby the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in further prescriptions and further side effects and unanticipated drug interactions, which itself may lead to further symptoms and further misdiagnoses. This is a pharmacological example of a feedback loop. Such cascades can be reversed through deprescribing.

Pharmacoepidemiology is the study of the uses and effects of drugs in well-defined populations.

Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists, medical affairs, and RWE scientists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up.

<span class="mw-page-title-main">Deprescribing</span> Process to taper or stop medications

Deprescribing is a process to taper or stop medications with the intention to achieve improved health outcomes by reducing exposure to medications that are potentially either harmful or no longer required. Deprescribing is important to consider with changing health and care goals over time, as well as polypharmacy and adverse effects. Deprescribing can improve adherence, cost, and health outcomes but may have adverse drug withdrawal effects. More specifically, deprescribing is the planned and supervised process of intentionally stopping a medication or reducing its dose to improve the person's health or reduce the risk of adverse side effects. Deprescribing is usually done because the drug may be causing harm, may no longer be helping the patient, or may be inappropriate for the individual patient's current situation. Deprescribing can help correct polypharmacy and prescription cascade.

Comprehensive geriatric assessment (CGA) is a process used by healthcare practitioners to assess the status of people who are frail and older in order to optimize their subsequent management. These people often have complex, multiple and interdependent problems (multimorbidity) which make their care more challenging than in younger people, or those with just one medical problem. CGA is the core work of specialists in the care of older people, although many other health care practitioners either have not heard of it, or are not aware of what it actually is. It is also called "multidimensional geriatric assessment."

Comprehensive medication management (CMM) is the process of delivering clinical services aimed at ensuring a patient's medications (including prescribed, over-the-counter, vitamins, supplements and alternative) are individually assessed to determine that they have an appropriate reason for use, are efficacious for treating their respective medical condition or helping meet defined patient or clinical goals, are safe considering comorbidities and other medications being taken, and are able to be taken by the patient as intended without difficulty.

<span class="mw-page-title-main">Somnifacient</span> Class of medications that induce sleep

Somnifacient, also known as sedatives or sleeping pills, is a class of medications that induces sleep. It is mainly used for treatment of insomnia. Examples of somnifacients include benzodiazepines, barbiturates and antihistamines.

References

  1. ↑ "MATCH-D Medication Appropriateness Tool for Comorbid Health conditions during Dementia". www.match-d.com.au. Retrieved 2019-06-01.
  2. 1 2 Page, A. T.; Potter, K.; Clifford, R.; McLachlan, A. J.; Etherton-Beer, C. (2016). "Medication appropriateness tool for co-morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel". Internal Medicine Journal. 46 (10): 1189–1197. doi:10.1111/imj.13215. PMC   5129475 . PMID   27527376.
  3. ↑ Etherton-Beer, Christopher; McLachlan, Andrew; Clifford, Rhonda; Potter, Kathleen; Page, Amy (2015-08-01). "Prescribing for Australians living with dementia: study protocol using the Delphi technique". BMJ Open. 5 (8): e008048. doi:10.1136/bmjopen-2015-008048. PMC   4538244 . PMID   26264272.
  4. ↑ Page, Amy; Etherton-Beer, Christopher; Seubert, Liza J.; Clark, Vaughan; Hill, Xaysja; King, Stephanie; Clifford, Rhonda M. (2018). "Medication use to manage comorbidities for people with dementia: a systematic review". Journal of Pharmacy Practice and Research. 48 (4): 356–367. doi: 10.1002/jppr.1403 .
  5. ↑ Wang, Kate; Alan, Janine; Page, Amy; Percival, Mia; Etherton-Beer, Christopher (2022). "Medication use to manage comorbidities in people with dementia: A systematic review". Journal of Pharmacy Practice and Research. 52 (3): 161–179. doi:10.1002/jppr.1802. S2CID   247574884.
  6. ↑ Quek, Hui Wen (April 2023). "Deprescribing considerations for older people in general practice". Australian Journal of General Practice. 52 (4): 173–180. doi:10.31128/AJGP-08-22-6547. PMID   37021442.
  7. ↑ "Reducing the burden of multiple medicines for older dementia patients". Radio National. 2015-05-22. Retrieved 2019-06-01.
  8. ↑ "MATCH-D study gains consensus on dementia medicines management". AJP. 2016-08-17. Retrieved 2019-06-01.
  9. ↑ "Tools to guide which medicines should be considered for deprescribing". Health Quality & Safety Commission. Retrieved 2023-02-10.
  10. ↑ "End of Life Care in Frailty: Medicines management". British Geriatrics Society. Retrieved 2022-02-03.
  11. ↑ "Tools to guide which medicines should be considered for deprescribing". Health Quality & Safety Commission. Retrieved 2023-02-11.
  12. ↑ "Health Quality & Safety Commission NZ" (PDF). Archived from the original (PDF) on 2021-04-15. Retrieved 2022-02-03.
  13. ↑ RACGP aged care clinical guide (Silver Book) 5th Edition. Royal Australian College of General Practitioners.
  14. ↑ "Medication appropriateness tool for co-morbid health conditions in dementia". All Events. Retrieved 2023-02-10.
  15. ↑ NPS MedicineWise (April 2022). "Medication Management Review Reports: Best practice recommendations" (PDF).
  16. ↑ NPS MedicinesWise (August 2021). "Changed Behaviour in Dementia" (PDF).
  17. 1 2 Etherton-Beer, Christopher D.; Parekh, Nikesh; Ryan, Cristin; Clark, Vaughan; King, Stephanie; Hill, Xaysja; McLachlan, Andrew J.; Seubert, Liza; Potter, Kathleen (2017-08-01). "Exploring the enablers and barriers to implementing the Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria in Australia: a qualitative study". BMJ Open. 7 (8): e017906. doi:10.1136/bmjopen-2017-017906. PMC   5724063 . PMID   28838905.
  18. ↑ Lee, Kenneth; O'Donnell, Lisa Kouladjian; Cross, Amanda; Hawthorne, Deborah; Page, Amy Theresa (2023-02-16). "Clinical pharmacists' reported approaches and processes for undertaking Home Medicines Review services: A national survey". Archives of Gerontology and Geriatrics. 109: 104965. doi:10.1016/j.archger.2023.104965. ISSN   0167-4943. PMID   36821873. S2CID   256968653.
  19. ↑ Cross, Amanda J.; Etherton-Beer, Christopher D.; Clifford, Rhonda M.; Potter, Kathleen; Page, Amy T. (1 April 2021). "Exploring stakeholder roles in medication management for people living with dementia". Research in Social and Administrative Pharmacy. 17 (4): 707–714. doi:10.1016/j.sapharm.2020.06.006. PMID   33722353. S2CID   219923285.
  20. ↑ Mueller, Christoph; Molokhia, Mariam; Perera, Gayan; Veronese, Nicola; Stubbs, Brendon; Shetty, Hitesh; Codling, David; Huntley, Jonathan; Stewart, Robert (June 2018). "Polypharmacy in people with dementia: Associations with adverse health outcomes". Experimental Gerontology. 106: 240–245. doi:10.1016/j.exger.2018.02.011. ISSN   1873-6815. PMID   29452289. S2CID   5045199.
  21. ↑ "ANZCTR - Registration".
  22. ↑ "Too much of a good thing: fundamentals of deprescribing". DTA. 2020-07-24. Retrieved 2021-04-08.
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