Drug prescription patterns, polypharmacy and potentially inappropriate medication in Swiss nursing homes: a descriptive analysis based on claims data

Schneider, Rahel; Reinau, Daphne; Schur, Nadine; Blozik, Eva; Früh, Mathias; Signorell, Andri; Meier, Christoph; Schwenkglenks, Matthias

doi:10.4414/smw.2019.20126

Cited by 20 publications

(43 citation statements)

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“…The prevalence of both polypharmacy and PIM was comparable to findings in recent data from Switzerland [4] but higher than previous estimates [3,9,10]. Participants in our study were older than in previous studies (> 75 years in our study vs. > 65 years).…”

Section: Polypharmacy and Prevalence Of Pimsupporting

confidence: 81%

“…Polypharmacy is heterogeneously defined in studies as the use of multiple medications by the patient, although most studies agree on a threshold of at least five medications [1]. In Switzerland, one-quarter of community-dwelling patients aged > 65 years self-report taking five or more drugs [2], although higher rates have been reported based on claims data [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of PIM varies according to age, context (community dwelling vs. care home) and the criteria used to define it [6][7][8]. Swiss data in community-dwelling patients aged > 65 years reported a prevalence of PIM around 20% [3,9,10], increasing to 74% in nursing home residents [4]. However, these studies were limited to claims data or conducted in specific populations, and clinical information to estimate inappropriate prescribing was often weak.…”

Section: Introductionmentioning

confidence: 99%

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Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Schnegg

Senn

Bugnon

et al. 2019

Drugs - Real World Outcomes

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Background We sought to estimate the prevalence of polypharmacy, the most prevalent drug classes involved, and the prevalence and type of potentially inappropriate prescribing among older male and female patients in family medicine. Methods We conducted a secondary analysis of baseline data from a pragmatic cluster-randomised trial on the efficacy of a screening and management tool for geriatric syndromes among older community-dwelling patients (aged ≥ 75 years) included by 42 family physicians. Information on drug prescription and clinical diagnoses (International Classification of Primary Care-2nd Edition [ICPC-2] coded) were extracted manually from medical records. The prevalence of polypharmacy, defined as the use of at least five permanent oral or parenteral drugs, and of potentially inappropriate medications (PIMs), identified according to 2015 updated Beers criteria, were compared between men and women. Results We included 429 patients (269 women and 160 men; mean age 82.9 and 81.8 years, respectively). Polypharmacy was found in 59.9% of them. Analgesics, antithrombotic agents and agents acting on the renin-angiotensin system were the most frequently prescribed drug categories. Three-quarters of patients (76.7%) were prescribed at least one PIM according to Beers criteria, without difference by sex/gender (p = 0.760). The most frequent PIMs were proton-pump inhibitors used for > 8 weeks, diuretics, benzodiazepines, aspirin for primary prevention, and chronic use of non-steroidal anti-inflammatory drugs. Prescription patterns markedly differed by sex/gender, but the number and patterns of inappropriate prescriptions were comparable overall. Interpretation Both polypharmacy and PIMs were very common in older patients followed regularly in family medicine in Switzerland. Interestingly, most PIMs involved only a limited number of medication classes. Trial registration Clinicaltrials.gov NCT 02618291.

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Section: Polypharmacy and Prevalence Of Pimsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Schnegg

Senn

Bugnon

et al. 2019

Drugs - Real World Outcomes

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“…Polypharmacy, commonly defined as the use of five or more concomitant drugs, and the use of potentially inappropriate medications (PIMs) are frequent problems among nursing home (NH) residents. Depending on estimations and definitions, the prevalence of polypharmacy ranges from 24% to 50% [1][2][3], and PIMs are prescribed to between 43% [4] and 90% [5] of NH residents. While polypharmacy is sometimes necessary to treat severe illness, and the use of a potentially inappropriate drug can be the best choice available for a specific patient, both are independently associated with worse health outcomes, lower quality of life, and increased risk of hospitalisation and death [1,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study

et al. 2020

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Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices of nurses, pharmacists, and physicians regarding deprescribing in Swiss NHs, referring to an implementation approach on three levels of action: the individual, the institution, and the healthcare system. Methods: Two focus groups were held with 21 participants: one focus group with 11 pharmacists, another with 10 nurses and six semi-structured interviews with physicians were conducted and focused on their individual experience and practices. They were audiotaped and fully transcribed, and a content analysis was performed using to MAXQDA (Ver 12) software. Results: (1) At an individual level, physicians were concerned by consequences of deprescribing in terms of safety. Nurses were closest to residents and stressed the importance of finding the right time, creating a bond of trust before deprescribing and considering the purpose of the stay in the NH. Pharmacists relied on structured guides for deprescribing, which led their reflection and practice. All professionals saw the complexity of the clinical situations, as well as residents’ and relatives’ fears of interruption of care. (2) At an institutional level, the professionals stressed the lack of time to discuss patients’ health and treatment, while pre-existing interprofessional collaboration, specifically, quality circles, seemed useful tools to create common knowledge. In order to reduce prescriptions, better coordination between physicians, nurses, pharmacists and specialists seemed crucial. (3) At the health system level, funding still needs to be provided to consolidate the process, go beyond organisational constraints and ensure deprescribing serves the patient’s wellbeing above all. Conclusions: At the individual level of implementation, the different healthcare professionals expressed specific concerns about deprescribing, depending on their defined role in NHs. Their perspective about the different levers to promote deprescribing at institutional and healthcare system levels converge towards interprofessional collaboration supported by the healthcare system. Specific funding and incentives are therefore needed to support a sustainable interprofessional team.

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“…Numerous studies have reported a high use of medication in nursing homes, with a substantial risk of inappropriate prescriptions [7][8][9]. Similarly, there is a considerable body of evidence attesting to the fact that the rate of use of potentially inappropriate medications remains high among nursing home residents [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

No impact of a prescription booklet on medication consumption in nursing home residents from 2011 to 2014: a controlled before–after study

Sanchez¹,

Payet

Herr

et al. 2020

Aging Clin Exp Res

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Background Older persons are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. We aimed to evaluate the impact on medication consumption, of a booklet designed to aid physicians with prescriptions for elderly nursing home residents. Methods Among 519 nursing homes using an electronic pill dispenser, we recorded the daily number of times that a drug was administered for each resident, over a period of 4 years. The intervention group comprised 113 nursing homes belonging to a for-profit geriatric care provider that implemented a booklet delivered to prescribers and pharmacists and specifically designed to aid with prescriptions for elderly nursing home residents. The remaining 406 nursing homes where no such booklet was introduced comprised the control group. Data were derived from electronic pill dispensers. The effect of the intervention on medication consumption was assessed with multilevel regression models, adjusted for nursing home status. The main outcomes were the average daily number of times that a medication was administered and the number of drugs with different presentation identifier codes per resident per month. Results 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (− 0.05 and − 0.06). The booklet did not have a statistically significant effect (exponentiated difference-indifferences coefficient 1.00, 95% confidence interval 0.99-1.02, P = .45). Conclusion We observed an overall decrease in medication consumption in both the control and intervention groups. Our analysis did not provide any evidence that this reduction was related to the use of the booklet. Other factors, such as national policy or increased physician awareness, may have contributed to our findings.

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Drug prescription patterns, polypharmacy and potentially inappropriate medication in Swiss nursing homes: a descriptive analysis based on claims data

Cited by 20 publications

References 0 publications

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study

No impact of a prescription booklet on medication consumption in nursing home residents from 2011 to 2014: a controlled before–after study

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