Medication review for people with dementia: effectiveness, cost-effectiveness and health inequality

Medication review (MR) counteract the use of inappropriate medication (IM), which is a common problem among the elderly. People living with dementia (PWD) are especially vulnerable to IM and MR is thus crucial for this group.

The Swedish National Board of Health and Welfare (NBHW) have specific regulations on who should receive a MR and when, i.e., patients ≥75-years of age or having ≥5 medications should receive an MR in the primary care, and while admitted to the hospital, living in assisted home care, nursing home, or assessed by a physician.Howerver, Swedish healthcare regions have their own rules and regulation regarding MR.

For example, in Skåne the age limit is ≥65; in Västra Götaland no limit on the number of drugs; in Östergötland no limit on either age or number of drugs.

However, research is limited on which MR model is (most) effective, cost-effective and contributes to a reduction in health inequality among PWD.We will create a database linking several national and local registers such as the Patient register, Pharmaceutical register, and regional databases on healthcare utilization.

The study sample includes all persons with a dementia diagnosis in the selected regions from 2013 (the year the MR guidelines were introduced by the NBHW) to 2022. A comparison group from the general population will be created, matched on age, sex, and area of residence. We will employ panel data analysis methods that exploit the longitudinal nature of the data.