Evaluating the quality of nursing home care

Howard, John B.; Strong, Kenneth E.

doi:10.1097/00006199-197803000-00046

Cited by 3 publications

(3 citation statements)

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“…Evaluation of the quality of medical care in a SNF is difficult (22) and it was our experience that cooperation from the attending physicians and skilled nursing personnel usually was not readily accorded. This reserved attitude suggests the need for greater efforts to establish a better rapport and enforce more effective means of auditing drug prescribing patterns and care plans for the patients.…”

Section: Discussionmentioning

confidence: 99%

Drug Utilization and Prescribing Patterns in a Skilled Nursing Facility: The Need for a Rational Approach to Therapeutics

Segal

Thompson

Floyd

1979

J American Geriatrics Society

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A study was made of 50 patients drawn at random from a Skilled Nursing Facility (SNF) attended by seven physicians. For 59 percent of these patients, polypharmacy was practiced but no substantiating diagnoses were recorded. Approximately half of the drugs were administered pro re nata. More drugs were prescribed in potentially toxic dosages than in subtherapeutic dosages. The risk of an adverse drug reaction (ADR) was most often associated with anticholinergic agents, sedative-hypnotic drugs, and neuroleptics (thioridazine and chlorpromazine), particularly when prescribed concurrently. Risk of an ADR was highest when a drug was prescribed without recording a definite diagnostic indication. Lack of consistency by individual physicians in their approaches to the therapy of similar disease entities in comparable patients tended to support the concept of peer review in SNFs and also the need for teaching a rational approach to therapeutics in SNFs based on clinical pharmacology as applied to the elderly.

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Section: Discussionmentioning

confidence: 99%

Drug Utilization and Prescribing Patterns in a Skilled Nursing Facility: The Need for a Rational Approach to Therapeutics

Segal

Thompson

Floyd

1979

J American Geriatrics Society

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“…Studies of prescribing patterns in nursing homes report inappropriate prescription of diuretics 32 and antipsychotics 33 ; also many incontinent patients receive drugs that could further impair bladder control 29 . Drugs are frequently inappropriately prescribed on an “as needed” basis, 34–35 the exact meaning of which is not specified to the nursing staff 27 . Reviewing medical records in a skilled nursing facility, Segal et al 36 found that there were no indications for 60% of the drugs prescribed.…”

Section: Resultsmentioning

confidence: 99%

The Quality of Medical Care Received by Older Persons

Siu

1987

J American Geriatrics Society

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This paper reviews studies published since 1970 on the quality of medical services received by older persons. Although many of the studies were flawed in design or limited in scope, they suggest that there are problems in the quality of care received by older persons in ambulatory, hospital, and nursing home settings. Changes in health care delivery and financing should attempt to improve, rather than merely maintain, the quality of medical and health services received by this vulnerable population.

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“…Recent studies show quality of care to be a complex construct both hard to define and difficult to guarantee (Stannard, 1973;Kahn _et al, 1977;Howard and Strong, 1977;George, 1979;Gustafson et al, 1980). …”

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confidence: 99%