Improving Use of Medicines for Older People in Long-Term Care: Contrasting the Policy Approach of Four Countries

Abstract

The quality of nursing home care for older people, including medication use and related outcomes, has been problematic in a number of developed countries. This paper compares the policy approaches to drug prescribing and administration in nursing homes adopted by four countries. The United States has led the way in terms of regulating and inspecting nursing homes, with strict requirements for prescribing psychotropic medications, commonly known as "chemical restraints." These requirements have been facilitated by detailed data collection mandated by the US government. Although regulation has led to marked reductions in the prescribing of these agents, underused medications have received little attention. Despite similar problems with the use of psychotropic drugs, the United Kingdom, Australia and New Zealand have adopted a more generic approach to drug use in the nursing home setting, a situation that may reflect the different organization and ethos of healthcare systems in these countries. Developments in systematic medication data capture, greater collaboration and more educational feedback to prescribers and facilities would represent a major step forward in long-term care policy in these latter three countries, while a broader educational focus would further support improvements in the US setting. RésuméLa qualité des soins dispensés dans les foyers pour personnes âgées est problématique dans plusieurs pays développés, et cette préoccupation s' est étendue à l'utilisation des médicaments et aux effets connexes. Le présent article compare les politiques adoptées par quatre pays à ce chapitre. Les États-Unis ont pris les devants en matière de régle-mentation et d'inspection des foyers pour personnes âgées et ont adopté des exigences strictes concernant la prescription de médicaments psychotropes, communément appelés « contraintes chimiques ». Ces exigences s' appuient sur une collecte de données détaillées, effectuée à la demande du gouvernement américain. Bien que la réglementa-tion ait mené à une réduction marquée du nombre d' ordonnances de ces agents, les médicaments sous-utilisés n' ont pas fait l' objet d'une promotion très musclée. Même s'ils ont eu des problèmes semblables avec l'utilisation des médicaments psychotropes, le Royaume-Uni, l' Australie et la Nouvelle-Zélande ont adopté une approche beaucoup plus générique en ce qui concerne l'utilisation des médicaments dans les foyers pour personnes âgées -approche qui reflète peut-être l' organisation et l' éthos différents qui caractérisent les systèmes de santé de ces pays. Les progrès réalisés dans la capture systématique des données sur les médicaments, une collaboration accrue et une rétroaction plus informative aux prescripteurs et aux établissements constitueraient un grand pas en avant dans les politiques sur les soins de longue durée dans ces trois pays, tandis qu'un accent accru sur l' éducation favoriserait l' apport d' améliorations dans le contexte états-unien. (Hughes and Lapane 2005). Policies to influence medication use in resi...

Is psychotropic medication use related to organisational and treatment culture in residential care

“…Very large facilities with one type of care only were excluded in order to maintain the ability to compare type of unit within one organisation. The average size of facilities is small in NZ (Hughes et al, 2008). Facility managers were approached in random order until sufficient facilities were enroled.…”

Prescribing for older people in nursing homes: strategies to improve prescribing and medicines use in nursing homes

“…As previously highlighted in Paper 1 (Parsons et al , 2011), quality of nursing home care, including medication use and related outcomes, has been the subject of intense investigation and scrutiny, particularly in the United States (Hughes & Lapane, 2005; Hughes et al. , 2008).…”

“…Nationally, Minimum Standards for Nursing homes for Older People have been introduced (Department of Health, 2003), and the Care Quality Commission inspects nursing homes and assesses them against these standards. However, the minimum standards applying to the use of medicines are considered to be a code of practice and as such do not have statutory force (Hughes et al. , 2008).…”

“…Good‐quality medication use in New Zealand has been advocated by a number of governmental agencies. The Safe and Quality Use of Medicines National Strategy (Safe and Quality Use of Medicines Group, 2005) was established with the aim of achieving safer, more effective and more appropriate use of medicines for the community; however, this strategy does not contain guidance specific to the nursing home setting (Hughes et al. , 2008).…”

Quality Use of Medicines: Policy and Practice

“…The United Kingdom (UK) included the supply of medicines as part of the National Health System (NHS), while in the United States of America (USA), the supply and payment of S. Hunt (*) Office of Aged Care Quality and Compliance, Australian Government Department of Health and Ageing e-mail: susan.hunt@health.gov.au medicines varies from state to state, with a mix of government initiatives, third party or insurance schemes and largely, consumer payments [2]. Canada has developed a number of initiatives to ensure access to essential medicines, which vary among provinces.…”