Cross-national comparison of medication use in Australian and Dutch nursing homes

Taxis, Katja; Kochen, Sjoerd; Wouters, Hans; Boersma, Froukje; Gerard, Maring Jan; Mulder, Hans; Pavlovic, Jugoslav; Stevens, G. A.; Andrew, McLachlan; Pont, Lisa G.

doi:10.1093/ageing/afx004

Cited by 10 publications

(20 citation statements)

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“…We found very high use of PPIs (about 46%), which were among the most commonly used drugs in our sample of NHs. The prevalence was similar to that found in recent studies in Australia and The Netherlands but definitely higher than in Finland, France, and the United States, where between 22% and 38% of NH residents were taking PPIs . This suggests an urgent need to avoid the increasing use of PPIs in NHs, optimizing their prescription, because their regular use in NHs has been associated with diarrhea and other adverse events and has heavy implications for drug costs …”

Section: Discussionsupporting

confidence: 85%

Overuse of proton pump inhibitors in nursing homes: An Italian multicenter observational study

Pasina

Novella

Elli

et al. 2020

Pharmacoepidemiology and Drug

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Purpose: To examine the prevalence of residents receiving proton pump inhibitors (PPIs) for evidence-based indications in a large sample of Italian nursing homes (NHs) and to assess the predictors of potentially inappropriate prescriptions.Methods: This study was conducted in a sample of Italian long-term care NHs. Information on drug prescription, diseases, and socio-demographic characteristics of NH residents was collected three times during 2018. Appropriate use of PPI was defined in accordance with the strongest evidence-based indications and the Italian criteria for PPI prescription.Results: Among the 2579 patients recruited from 27 long-term care NHs, 1177 (45.6%) were receiving PPIs; 597 (50.7%) were taking them for evidence-based indications. Corticosteroids, anticoagulants, and mean number of drugs were the most important predictors of inappropriate PPIs prescriptions. NH residents receiving ≥13 drugs had about 10 times the risk of receiving a PPI than those taking 0 to 4 drugs.Similarly, residents with more comorbidity had about 2.5 times the risk of receiving a PPI than those in better health. The prevalence of residents inappropriately treated with PPI in individual NHs varied widely, ranging from 22% to 63%.Conclusions: Number of drugs, comorbidity, corticosteroids, and anticoagulants are the most important predictors of the inappropriate use of PPI in NHs. The wide variability between NHs in the appropriate use of PPIs suggests the need for thorough drug review in this fragile and vulnerable population. Prescribing patterns linked to evidence-based guidelines and national recommendations are essential for rational, cost-effective use of PPIs. K E Y W O R D Snursing homes, overuse, pharmacoepidemiology, proton pump inhibitors

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Section: Discussionsupporting

confidence: 85%

Overuse of proton pump inhibitors in nursing homes: An Italian multicenter observational study

Pasina

Novella

Elli

et al. 2020

Pharmacoepidemiology and Drug

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“…acetaminophen, fentanyl, or oxycodone) were often prescribed. This is in line with other studies examining drug utilization in nursing home residents [2,21,22]. Of the 341 different medications used, 34 were identified as suitable candidates for ODF formulation development in a (hospital) pharmacy environment.…”

Section: Discussionsupporting

confidence: 86%

“…Although, medication use of nursing home residents has been studied widely [21,22], there has been little attention to use such data as a basis to select candidates for age-appropriate and personalized geriatric medicinal products. In this study, the medication use of nursing home residents was examined to identify medications that are suitable for ODF formulation development, taking into account information on drug utilization and manufacturing-related characteristics of the drugs.…”

Section: Introductionmentioning

confidence: 99%

Orodispersible films as a personalized dosage form for nursing home residents, an exploratory study

et al. 2020

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Background A frequent problem in ageing patients, and thus in nursing home residents, is dysphagia, affecting the ability to swallow solid dosage forms. A promising and personalized drug delivery system for this patient group is the orodispersible film. Orodispersible films could be prepared extemporaneously in a (hospital) pharmacy setting or in specialty compounding community pharmacies using the solvent casting method. Little has been done to systematically investigate which medications should be chosen for orodispersible film formulation development. Objective In this study, the medication use of nursing home residents was examined to identify medications that are suitable for orodispersible film formulation development. Setting Nursing homes of three Northern provinces of Netherlands. Method Medication intake data from 427 nursing home residents from nine nursing homes from the three northern provinces of the Netherlands were used to identify candidates for orodispersible film formulation development. A stepwise approach, with exclusion steps, was used. Selection criteria included systemic use with a maximum amount of 100 mg per dose unit, no commercially available suitable dosage forms for administration in dysphagia, indication for diseases associated with dysphagia. Furthermore, the characteristics of the active pharmaceutical ingredient needed for the orodispersible film formulation development, such as water solubility and taste, were reviewed. Main outcome measure Active pharmaceutical ingredients suitable for orodispersible film formulation development. Results The nursing home residents used three hundred forty one different medications. Of those, 34 active pharmaceutical ingredients from six therapeutic groups were considered as candidates for orodispersible film formulation development. Most of these active pharmaceutical ingredients have a bitter taste and poor water solubility, which is a challenge for orodispersible film production. Conclusions The most suitable active pharmaceutical ingredient candidates for manufacturing of orodispersible films for the ageing patient population may be the combination of levodopa and carbidopa used to treat the symptoms of Parkinson's disease, and baclofen used to treat spasticity.

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“…Anticholinergic/sedative medications mostly act on the central nervous system (CNS) and include psycholeptics, psychoanaleptics, and analgesics . So far, most research has focused on quantifying the cumulative exposure of multiple anticholinergic/sedative medications in older patients with polypharmacy . Little is known about the prevalence of combinations of multiple anticholinergic/sedative medications resulting in a high load or whether subgroups of these patients based on types of anticholinergic/sedative medications used can be identified.…”

Section: Introductionmentioning

confidence: 99%

Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

Meer

Taxis

Teichert

et al. 2019

Pharmacoepidemiology and Drug

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Purpose To identify the proportion of older adults with a high anticholinergic/sedative load and to identify patient subgroups based on type of central nervous system (CNS)‐active medication used. Methods A cross‐sectional study of a nationwide sample of patients with anticholinergic/sedative medications dispensed by 1779 community pharmacies in the Netherlands (90% of all community pharmacies) in November 2016 was conducted. Patients aged older than 65 years with a high anticholinergic/sedative load defined as having a drug burden index (DBI) greater than 1 were included. Proportion of patients with a high anticholinergic/sedative load was calculated by dividing the number of individuals in our study population by the 2.4 million older patients using medications dispensed from study pharmacies. Patient subgroups based on type of CNS‐active medications used were identified with latent class analysis. Results Overall, 8.7% (209 472 individuals) of older adults using medications had a DBI greater than 1. Latent class analysis identified four patient subgroups (classes) based on the following types of CNS‐active medications used: “combined psycholeptic/psychoanaleptic medication” (class 1, 57.9%), “analgesics” (class 2, 17.9%), “antiepileptic medication” (class 3, 17.8%), and “anti‐Parkinson medication” (class 4, 6.3%). Conclusions A large proportion of older adults in the Netherlands had a high anticholinergic/sedative load. Four distinct subgroups using specific CNS‐active medication were identified. Interventions aiming at reducing the overall anticholinergic/sedative load should be tailored to these subgroups.

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Cross-national comparison of medication use in Australian and Dutch nursing homes

Cited by 10 publications

References 0 publications

Overuse of proton pump inhibitors in nursing homes: An Italian multicenter observational study

Overuse of proton pump inhibitors in nursing homes: An Italian multicenter observational study

Orodispersible films as a personalized dosage form for nursing home residents, an exploratory study

Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

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