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

Abstract

Background/objectivesOur aim was to describe the prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in Belgian nursing homes and to identify characteristics of residents, general practitioners (GPs), and nursing homes (NHs) that are associated with the number of PIMs and PPOs. DesignA cross-sectional study. Settingand Participants: Nursing home residents (NHRs), aged ≥65 years, not in palliative care were included in 54 Belgian NHs participating in the COME-ON study. MeasuresInstances of PIMs were detected using a combination of the STOPP v2 and AGS 2015 Beers criteria. Instances of PPOs were detected using START v2. To assess factors associated with the number of PIMs and PPOs, a multivariate binomial negative regression analysis was performed. ResultsA total of 1410 residents, with a median age of 87 years, was included. The median number of medications taken was 9. PIMs were detected in 88.3% of NHRs and PPOs in 85.0%. Use of benzodiazepines (46.7%) and omission of vitamin D (51.5%) were the most common PIM and PPO, respectively. The factor most strongly associated with increased PIMs was the use of 5 to 9 drugs or ≥10 drugs [relative risk (RR) (95% confidence interval [CI]: 2.27 (1.89, 2.76) and 4.04 (3.37, 4.89), respectively]. The resident's age was associated with both decreased PIMs and increased PPOs. PIMs and PPOs were also associated with some NH characteristics, but not with GP characteristics. ConclusionImplications: The high prevalence of PIMs and PPOs remains a major challenge for the NH setting. Future interventions should target in priority residents taking at least 10 medications and/or those taking psychotropic drugs. Future studies should explore factors related to organizational and prescribing culture. Moreover, special attention must be paid to the criteria used to measure inappropriate prescribing, including criteria relative to underuse.