Life In The Slower Lane

Here is the PICO analysis for the twenty-fifth uploaded article:

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✅ PICO Analysis

Full Article Title:

Systematic Review of Interdisciplinary Interventions in Nursing Homes

Type of Study:

Systematic review of randomised controlled trials (RCTs)

Journal and Year:

Journal of the American Medical Directors Association (JAMDA), 2013; 14(7):471–478

DOI: 10.1016/j.jamda.2013.02.005

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P – Population

• Setting:
  • Nursing homes (NHs) or residential care facilities
• Participants:
  • Older adults (mean age >65 years) residing in long-term care settings
• Number of Studies:
  • 27 RCTs included in the final review
• Geographic Spread:
  • United States, Australia, United Kingdom, Netherlands, Taiwan, Germany, Sweden, New Zealand, Denmark, Austria 

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I – Intervention

• Nature of Interventions:
  • Interdisciplinary interventions involving more than one professional discipline (e.g. physicians, nurses, pharmacists, therapists, social workers, administrators)
  • Interventions included:
    • Education and training
    • Case conferences
    • Medication reviews
    • Falls prevention programs
    • Behaviour management plans
    • Environmental modifications
    • Structured team meetings with formal roles and leadership in some trials
• Team Elements Analysed:
  • Leadership
  • Communication and coordination
  • Conflict management
  • Physician (particularly primary care physician, PCP) and pharmacist involvement 

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C – Comparison

• Comparator:
  • Usual care or standard practice within nursing homes
  • In all cases, comparison was between interdisciplinary interventions versus control conditions (standard practice or minimal intervention) within RCTs

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O – Outcomes

Primary Findings:

• Overall Positive Outcomes:
  • 18 of 27 trials (66%) demonstrated significant improvement in the primary outcome
• Highest Impact Interventions:
  • Involvement of a pharmacist: 100% (4/4) success
  • Involvement of the resident’s primary care physician (PCP): 100% (6/6) success
  • Formal team meetings: 75% (9/12) success
  • Teams with clear communication and coordination mechanisms: 88% (8/9) success
  • Teams with designated leadership: 100% (4/4) success 

Targeted Outcomes Included:

• Reduction in antipsychotic or inappropriate medication use
• Improved behavioural management
• Falls reduction
• Enhanced nutrition
• Improved antibiotic stewardship
• Improved quality indicators (e.g. continence, pressure injuries, functional status)

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Outcome Classification

• Person-centred outcomes:
  • Improvement in behavioural symptoms, depression, falls, functional status, and quality of life
• Process outcomes:
  • Enhanced care planning, medication review practices, team communication, and interprofessional collaboration
• Health system outcomes:
  • Some trials showed reduced hospitalisation, improved prescribing patterns, and more efficient resource use (e.g. through interdisciplinary case conferencing)

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Summary Conclusion

This systematic review shows that interdisciplinary interventions in nursing homes lead to improved resident outcomes in two-thirds of trials. Successful interventions consistently included structured communication, coordination, and team leadership. Inclusion of primary care physicians and pharmacists on the care team was strongly associated with positive results. The review supports integrating well-structured, team-based care into routine nursing home operations and highlights the need for clearer definition, role clarity, and planning to optimise team impact in long-term care settings .

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