Medication use in Italian nursing homes: preliminary results from the national monitoring system

Abstract

Background: The aging population has increased concerns about the affordability, quality, and nature of long-term care for older people, emphasizing the role of nursing homes. Unlike acute hospital and primary care, there is a lack of drug consumption data in long-term care to understand regional or national healthcare policies.Objectives: This study aimed to describe medication consumption by older adults and expenditure in Italian nursing homes (NHs).Methods: Data on drug consumption and costs from the administrative medicine informational flows that detect medicines packages supplied to patients in health facilities and NHs were used. Data on the characteristics of the healthcare residence were from the Italian Health Ministry. Records for the year 2019, selecting the nursing homes exclusively providing elderly or mixed (elderly and disabled) were used.Results: In 2019, the total expenditure on medicines in NHs amounted to 25.38 million euros, the average cost to 1.30 and the expenditure per bed to 436.18 euros. Cardiovascular drugs were the highest-consuming therapeutic class (177.0 defined daily doses—DDDs/100 days of NH stay; 22.2% of total) followed by drugs acting on the alimentary tract and metabolism (167.6% and 21.0%) and blood drugs (160.4% and 20.1%). The treatment of hypertension and heart failure was widely the most frequently used, with the consumption being driven mainly by furosemide and ramipril. Antiulcer drugs were used on average in more than half of the days of NH stay (58.5 DDDs/100 days of NH stay), representing a therapeutic category for which deprescribing initiatives are recommended. On average, almost all patients received a dose of benzodiazepines, antipsychotics and antidepressants (37.6, 35.9, and 17.7 DDDs/100 days of NH stay, respectively), confirming the high prevalence of use for these medicines. Antibiotics reached 6.8 DDDs/100 days of NH stay.Conclusion: The availability of data in this specific setting allows the identification of the main interventions toward improving appropriateness and represents a challenge for drug utilization research. Data from this study suggest that proton pump inhibitors (PPIs), benzodiazepines and antibacterials can be areas of improving prescribing appropriateness.

Antibiotic consumption in French nursing homes between 2018 and 2022: A multicenter survey

“…21 Altogether, fluoroquinolones represented almost 7% of total consumption. This is higher than reported in Norway in 2016 (5.2% of total antibiotic consumption in 34 nursing homes) 18 but much lower than described in Italy 22 and the United States. 26 Although not significantly, fluoroquinolones consumption tended to decrease, in accordance with professional recommendations to restrict the use of these antibiotics.…”

“…However, it remains the most consumed antibiotic. In 2019, it was also the most used antibiotic in a sample of 802 Italian nursing homes, where it accounted for almost 40% of their antibiotic consumption, 22 compared to 35% in our survey (12.8 of 36.5). In contrast, amoxicillin, which is the most recommended antibiotic depending on the bacteria susceptibility, 21 was the second most consumed antibiotic.…”

“…Interestingly, this first-line antibiotic ranked only 11 among most used antibiotics in Italian nursing homes in 2019. 22 …”

“…Interestingly, this first-line antibiotic ranked only 11 among most used antibiotics in Italian nursing homes in 2019. 22 Ceftriaxone was the third most consumed antibiotic and the first among cephalosporins. Indeed, this molecule is recommended in pyelonephritis, prostatitis, bronchitis when the oral route is not possible or in pneumopathy as a second-line treatment.…”

Pharmacological treatments and medication-related problems in nursing homes in Catalonia: a multidisciplinary approach

“…Advances in research and medical care have increased life expectancy, and the aging of the population is expected to increase significantly in the coming decades ( Guisado-Clavero et al, 2019 ; Zito et al, 2023 ). In 2022, more than one-fifth (21.1%) of the European Union population was aged 65 or over, and the elderly are expected to account for 31.3% by 2100 ( Eurostat, 2023 ).…”