Drug Use in Swedish Nursing Homes

Claesson, Cecilia B.; Schmidt, Inger Kappel

doi:10.2165/00044011-199816060-00004

Cited by 20 publications

(22 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A weighted score is generated to express the degree of prescribing appropriateness. Four other studies evaluated the appropriateness of drugs according to explicit criteria, using guidelines from the Swedish Medical Product Agency (Schmidt 1998 [26]/Claesson 1998 [12]), guidelines issued in connection with OBRA (US Ombudsman Reconciliation Act) (Furniss 2000 [17]), Beers' criteria (Midlöv 2002 [23]) or a novel algorithm developed for the study purpose (Patterson 2010 [29]). Beers' criteria are a list of drugs that should be avoided in the elderly in general or in elderly with specific disorders and gives indications of maximum doses [31].…”

Section: Resultsmentioning

confidence: 99%

“…This was also the case for the pharmacist medication review performed in one of the studies that we classified as educational meetings with at least one additional intervention (Roberts 2001 [24]). In the third study without a statistically significant effect the pharmacist was active in a multidisciplinary team and presumably gave recommendations or feedback orally during the meetings, but without any medication review done beforehand (Schmidt 1998 [26]/Claesson 1998 [12]).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials

et al. 2011

View full text Add to dashboard Cite

BackgroundStudies have shown that residents in nursing homes often are exposed to inappropriate medication. Particular concern has been raised about the consumption of psychoactive drugs, which are commonly prescribed for nursing home residents suffering from dementia. This review is an update of a Norwegian systematic review commissioned by the Norwegian Directorate of Health. The purpose of the review was to identify and summarise the effect of interventions aimed at reducing potentially inappropriate use or prescribing of drugs in nursing homes.MethodsWe searched for systematic reviews and randomised controlled trials in the Cochrane Library, MEDLINE, EMBASE, ISI Web of Knowledge, DARE and HTA, with the last update in April 2010. Two of the authors independently screened titles and abstracts for inclusion or exclusion. Data on interventions, participants, comparison intervention, and outcomes were extracted from the included studies. Risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Table and GRADE, respectively. Outcomes assessed were use of or prescribing of drugs (primary) and the health-related outcomes falls, physical limitation, hospitalisation and mortality (secondary).ResultsDue to heterogeneity in interventions and outcomes, we employed a narrative approach. Twenty randomised controlled trials were included from 1631 evaluated references. Ten studies tested different kinds of educational interventions while seven studies tested medication reviews by pharmacists. Only one study was found for each of the interventions geriatric care teams, early psychiatric intervening or activities for the residents combined with education of health care personnel. Several reviews were identified, but these either concerned elderly in general or did not satisfy all the requirements for systematic reviews.ConclusionsInterventions using educational outreach, on-site education given alone or as part of an intervention package and pharmacist medication review may under certain circumstances reduce inappropriate drug use, but the evidence is of low quality. Due to poor quality of the evidence, no conclusions may be drawn about the effect of the other three interventions on drug use, or of either intervention on health-related outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials

et al. 2011

View full text Add to dashboard Cite

show abstract

“…Residents of nursing homes are considered an especially vulnerable population due to frequent physical, cognitive and sensory impairments and complex disabilities [7, 8]. In Germany, as in other European countries, regular review and adjustment of medication is not ensured in many institutions [9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…Outcome measures were heterogeneous and results varied widely: on the one hand studies showed significant improvements in medication appropriateness measured by the Medication Appropriateness Index (MAI) [8] and Beers criteria [20] as well as significant improvements in number of drug-drug interactions [20] and number of drugs [12, 20]. Other studies found no effects on number of drugs, costs or on medication appropriateness according to Medical Product Agency guidelines (which represents a country-specific Swedish list of drugs with possible effects of cognitive impairment that was used before the introduction of Beers criteria or generally applicable PIP lists) [7, 10]. However, combined interprofessional approaches consisting of educational training and structured medication review processes [8, 21, 22] seem to be most promising.…”

Section: Introductionmentioning

confidence: 99%

Effect of training and structured medication review on medication appropriateness in nursing home residents and on cooperation between health care professionals: the InTherAKT study protocol

et al. 2017

View full text Add to dashboard Cite

BackgroundPharmacotherapy in residents of nursing homes is critical due to the special vulnerability of this population. Medical care and interprofessional communication in nursing homes are often uncoordinated. As a consequence, polypharmacy and inappropriate medication use are common and may lead to hospitalizations and health hazards. The aim of this study is to optimize communication between the involved professional groups by specific training and by establishing a structured medication review process, and to improve medication appropriateness and patient-relevant health outcomes for residents of nursing homes.Methods/DesignThe trial is designed as single-arm study. It involves 300 nursing home residents aged ≥ 65 years and the members of the different professional groups practising in nursing home care (15–20 general practitioners, nurses, pharmacists). The intervention consists of interprofessional education on safe medication use in geriatric patients, and a systematic interprofessional therapy check (recording, reviewing and adapting the medication of the participating residents by means of a specific online platform). The intervention period is divided into two phases; total project period is 3 years.Primary outcome measure is the change in medication appropriateness according to the Medication Appropriateness Index. Secondary outcomes are cognitive performance, occurrence of delirium, agitation, tendency of falls, total number of drugs, number of potentially dangerous drug-drug interactions and appropriateness of recorded analgesic therapy regimens according to the Medication Appropriateness Index.Data are collected at t0 (before the start of the intervention), t1 (after the first intervention period) and t2 (after the second intervention period). Cooperation and communication between the professional groups are investigated twice by qualitative interviews.DiscussionThe project aims to establish a structured system for monitoring of drug therapy in nursing home residents. The newly developed online platform is designed to systematize and to improve the communication between the professional groups and, thus, to enhance quality and safety of drug therapy. Limitations of the study are the lack of a control group and the non-randomly recruited study sample.Trial registrationDRKS Data Management, DRKS-ID: DRKS00007900

show abstract

“…Ten nursing homes were selected from an original sample of 36. The original 36 nursing homes were selected according to a number of criteria reported elsewhere (Claesson & Schmidt 1998, Schmidt 2000) and were judged to be representative of nursing homes in Sweden, according to size, staff resources, and the residents’ age, sex and medical diagnosis. Out of the 36 nursing homes, 10 were selected for the present study based on staff ratings of social climate: five homes with the highest ratings and five with the lowest ratings (National Swedish Board of Health and Welfare 2000).…”

Section: Methodsmentioning

confidence: 99%

Family members’ perceptions of pain and distress related to analgesics and psychotropic drugs, and quality of care of elderly nursing home residents

Hall‐Lord

Johansson

Schmidt

et al. 2003

Health &Amp; Social Care in the Community

View full text Add to dashboard Cite

The aims of the present study were: (1) to describe family members' perceptions of nursing homes residents' pain and distress in relation to analgesics and psychotropic drugs; and (2) to compare whether background variables, dementia, help/support, prescribing of analgesics and psychotropic drugs, and quality of care vary between subgroups of residents. Two hundred and thirty-two family members of elderly people in 10 Swedish nursing homes participated in the study. The participants responded to a questionnaire including background variables, pain and distress variables, and the Quality from the Patient's Perspective (QPP) questionnaire. Data on drug prescribing was obtained from the medical records. The head nurse on each ward noted whether or not the resident had a documented or known diagnosis of dementia. The results showed that a high frequency of elderly nursing home residents were estimated as having physical pain and worry. A large number of the residents were prescribed psychotropic drugs. In addition, some of the residents with moderate or severe physical pain were not prescribed any analgesics. The residents were divided into three subgroups based on scores of physical discomfort, physical pain and worry. Subgroup comparisons differed with regard to sex, help/support, drugs and quality of care. Staff have a responsibility to assess the residents' pain and distress since this will form a basis for better pain and distress management. Other suggestions for improving quality of care are the provision of better information to the family members and the residents, meaningful occupation, less task-oriented care, and care that involves residents.

show abstract

Drug Use in Swedish Nursing Homes

Cited by 20 publications

References 34 publications

Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials

Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials

Effect of training and structured medication review on medication appropriateness in nursing home residents and on cooperation between health care professionals: the InTherAKT study protocol

Family members’ perceptions of pain and distress related to analgesics and psychotropic drugs, and quality of care of elderly nursing home residents

Contact Info

Product

Resources

About