Evaluation of prescribing quality in nursing homes based on drug-specific indicators: The Bergen district nursing home (BEDNURS) study

Abstract

Objectives:To examine prescribing quality among nursing home patients. Methods: A cross sectional study in 23 nursing homes, based on drug charts. The evaluation of prescribing quality was based on selected drug-specific indicators established by the Swedish National Board of Health and Welfare. Logistic regression analysis was used to examine associations between prescribing indicators and predictors related to patient (age, gender, drug number) and institution (nurse and physician staff time) characteristics. Results: A total of 1513 nursing home patients (76% women, mean age 85 years) were included in the study. On average, the patients used 5.1 (SD 2.5) standing medications. Laxatives were most commonly used (58%), followed by loop-diuretics (35%), antidepressants (31%), and anti-thrombotic agents (27%). Altogether 850 (56%) patients used at least one potentially inappropriate prescription (PIP), including long-term use of contact laxatives without proper indication (25%), long-acting benzodiazepines (17%), and anticholinergic drugs (16%). The number of drugs used was the most important determinant for any PIP as well as for all individual indicators (p<0.001). Relatively younger patients were more likely to receive any PIP, and in particular anticholinergic drugs, multiple psychotropic drugs, and interacting drugs (p<0.05). Conclusion: Prescribing quality assessment by use of drug-specific indicators revealed great potentials for improving drug therapy in Norwegian nursing homes.

Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs

“…The prevalence of PIMs in NHs in this study was lower compared with that in previous NH studies in Norway and other Nordic countries regarding long‐acting benzodiazepines, anticholinergic drugs, and multiple psychotropic drugs . However, concomitant use of three or more psychotropic drugs in our study was more prevalent than reported in previous Norwegian cross‐sectional studies in the community and in NHs…”

Concomitant use of anti‐dementia drugs with psychotropic drugs in Norway—a population‐based study

“…In this study, about 16% of the patients who used anti‐dementia drugs also used antipsychotics concomitantly. Considering that this sample mainly consisted of outpatients, these figures seem in line with two Norwegian studies from different nursing homes, finding that 16–26% of the patients used antipsychotics . The present sample may include patients with psychiatric disorders that already were taking antipsychotic drugs as part of their main treatment regime before developing dementia.…”

Potentially Inappropriate Prescribing in Belgian Nursing Homes: Prevalence and Associated Factors

“…Similarly, younger age has been associated with a higher rate of PIMs. 11,22,23,28 The oldest residents may have fewer comorbidities, reflecting a "survival of the fittest." 22,23 Furthermore, GPs may be more cautious in prescribing because they see very old residents as frailer.…”

“…11,22,23,28 The oldest residents may have fewer comorbidities, reflecting a "survival of the fittest." 22,23 Furthermore, GPs may be more cautious in prescribing because they see very old residents as frailer. 15,22 However, many studies in NHs have not demonstrated this association.…”