Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study

Abstract

Aim: Based on a multidisciplinary review of drug use in nursing home residents, this study aimed to identify the most frequent clinically relevant medication problems and to analyse them according to the drugs involved and types of problems. Methods: Cross sectional study auditing drug use by 1354 residents in 23 nursing homes in Bergen, Norway. Data were collected in 1997. A physician/pharmacist panel performed a comprehensive medication review with regard to indications for drug use and active medical conditions. The drug related problems were subsequently classified according to the drugs involved and types of problems (indication, effectiveness, and safety issues). Results: 2445 potential medication problems were identified in 1036 (76%) residents. Psychoactive drugs accounted for 38% of all problems; antipsychotics were the class most often involved. Multiple psychoactive drug use was considered particularly problematic. Potential medication problems were most frequently classified as risk of adverse drug reactions (26%), inappropriate drug choice for indication (20%), and underuse of beneficial treatment (13%).

The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients

“…Four of the authors (SR, JS, OS, and TBW), of whom three are professors in general practice (JS), clinical pharmacology (OS), and geriatrics (TBW) respectively, generated a list of 37 explicit criteria based on among others the Beers criteria with updates [7Á9], Swedish recommendations [11], previous and present Norwegian studies [12], more recent evidence from the literature [13Á34], and experiences from their own clinical practices. The criteria for pharmacological inappropriateness were related to patients ]70 years in general practice.…”

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

“…Patient recruitment and data collection has been described in detail elsewhere (8). Briefly, 23 nursing homes in greater Bergen agreed to participate in a cross sectional study auditing drug prescribing quality.…”

“…Various measures have been developed to evaluate prescribing quality, e.g. explicit indicators (4,5), adverse drug events (6), and multidimensional indicators (7,8). However, there is no universal definition of medication appropriateness, because quality may be assessed in different ways, depending on data available (prescription database vs. individual assessments), setting, and comprehensiveness.…”

Forskrivning, bruk og dokumentasjon av effekt

“…Disse viser at gjennomsnittspasienten får forskrevet fra fem til 11,5 legemidler, avhengig av om både faste og behovslegemidler er inkludert og hvilken metode som er benyttet (4-7). Samtidig bruk av flere legemidler, såkalt polyfarmasi, øker risikoen for legemiddelrelaterte problemer (LRP), og tre av fire sykehjemspasienter har minst ett legemiddelrelatert problem (6). LRP defineres som «hendelser eller forhold som skjer i forbindelse med legemiddelbehandling og som faktisk eller potensielt interfererer med ønsket helseeffekt» (8,9).…”