A pilot study of a Medication Rationalization (MERA) intervention

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Figure 1
Patient enrolment CONSORT flow diagram. The term bedspaced means that the patient was admitted geographically to a ward other than the usual medical ward because of a lack of bed availability. MERA = Medication Rationalization.
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Figure 2
Flow chart of medication recommendations and changes.

Table 1: Demographic and baseline characteristics of intervention and comparison group

Characteristic	Intervention group (n = 53)	Non-MERA comparison group (n = 51)	p value for difference between intervention and comparison groups
Age, yr, mean ± SD	79.6 ± 11.7	79.2 ± 13.4	0.9*
Sex, male, n (%)	30 (57)	19 (37)	0.048†
Mean hospital length of stay, mean ± SD	10.6 ± 8.4	7.7 ± 17.0	0.3*
Admission diagnosis, n (%)
Cancer	10 (19)	10 (20)
Cardiovascular (e.g., stroke, myocardial infarction)	6 (11)	9 (18)
Respiratory (e.g., COPD exacerbation, pneumonia)	12 (23)	7 (14)
Gastrointestinal (e.g., gastrointestinal bleed, cirrhosis)	9 (17)	6 (12)
Other (e.g., failure to cope)	16 (30)	19 (37)
Main criterion for inclusion, n (%)			0.6†
Age > 80 yr	22 (42)	23 (45)
Metastatic cancer	20 (38)	21 (41)
End-stage organ failure	11 (21)	7 (14)
Medications at the time of enrolment (intervention group) or day 3 of admission (comparison group), mean ± SD	13.3 ± 6.1	10.9 ± 4.5	0.03‡
Clinical Frailty Score, n (%)
1-3	21 (40)	NA
4-5	18 (35)	NA
6-8	13 (25)	NA
Followed by a palliative care consultant before MERA intervention	12 (23)	NA

Note: COPD = chronic obstructive pulmonary disease, MERA = Medication Rationalization, NA = not available, SD = standard deviation.

*t test.

†χ² test.

‡ Mann-Whitney U test.

Table 2: Differences in medication discontinuation among groups and subgroups

Variable	No. of medication discontinuations, mean ± SD	p value for difference
MERA intervention group	3.1 ± 2.6	< 0.001*
Non-MERA comparison group	0.9 ± 1.5	< 0.001*
Within intervention group
Main inclusion criterion		0.6†
Age > 80 yr	3.0 ± 3.1
Metastatic cancer	2.8 ± 1.7
End-stage organ failure	3.6 ± 2.9
Role of palliative care		0.4†
Followed by palliative care specialist	4.0 ± 2.8
Never followed by palliative care specialist	2.8 ± 2.3
Palliative care consultation suggested by MERA team but refused by admitting team or patient	2.8 ± 3.3

Note: MERA = Medication Rationalization, SD = standard deviation.

*Mann-Whitney U test.

†Kruskal-Wallis ANOVA.

Table 3: Most common medications recommended to be stopped by the MERA team

MERA medication class	No. of times MERA team recommended discontinuation (% of all recommended discontinuations), n = 201	No. of patients in whom medication class was recommended to be stopped (% of all patients enrolled), n = 53
Vitamins/minerals	55 (27)	28 (53)
Lipid-lowering agents	20 (10)	20 (38)
Homeopathic/herbal supplements	14 (7)	6 (11)
Proton pump inhibitors	13 (6)	13 (25)
Docusate	8 (4)	8 (15)
Antiplatelet agents	7 (3)	7 (13)
Benzodiazepines	6 (3)	6 (11)
Bisphosphonates (oral)	5 (2)	5 (9)
Dihydropyridine calcium-channel blockers	5 (2)	5 (9)
Opioids	5 (2)	5 (9)
Acetaminophen	4 (2)	4 (8)
Iron (oral)	4 (2)	4 (8)
Nonbenzodiazepine hypnotics	4 (2)	4 (8)
Thiazide diuretics	4 (2)	4 (8)