Variation between nursing homes in drug use and in drug-related problems

Amura Francesca Fog,Ibrahimu Mdala,Jørund Straand,Knut Engedal

doi:10.1186/s12877-020-01745-y

Amura Francesca Fog, Ibrahimu Mdala + Show 2 more

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https://doi.org/10.1186/s12877-020-01745-y

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Abstract

BackgroundResidents at nursing homes (NHs) are at particular risk for drug related harm. Regular medication reviews using explicit criteria for pharmacological inappropriateness and classification of drug related problems (DRPs) have recently been introduced as measures to improve the quality of medication use and for making the treatment more uniform across different institutions. Knowledge about variation in DRPs between NHs is scarce. To explore if increased attention towards more appropriate drug treatment in NHs have led to more uniform treatment, we have analyzed variations between different nursing homes’ drug use and DRPs.MethodsCross-sectional medication review study including 2465 long-term care residents at 41 NHs in Oslo, Norway. Regular drug use was retrieved from the patients’ medical records. DRPs were identified by using STOPP/START and NORGEP criteria and a drug-drug interactions database. NHs were grouped in quartiles based on average levels of drug use. The upper and lower quartiles were compared using independent samples t-test and associations between drug use and DRPs were tested by logistic regression.ResultsPatients’ mean age was 85.9 years, 74.2% were women.Mean numbers of regular drugs per patient was 6.8 and varied between NHs from 4.8 to 9.3.The proportion of patients within each NH using psychotropic and analgesic drugs varied largely: antipsychotics from three to 50%, benzodiazepines from 24 to 99%, antidepressants from nine to 75%, anti-dementia drugs from no use to 42%, opioids from no use to 65% and paracetamol from 16 to 74%.Mean DRPs per patient was 2.0 and varied between NHs from 0.5 to 3.4.The quartiles of NHs with highest and lowest mean drugs per patient (7.7 vs. 5.7, p < 0.001) had comparable mean number of DRPs per patient (2.2 vs. 1.8, p = 0.2). Using more drugs and the use of opioids, antipsychotics, benzodiazepines and antidepressants were associated with more DRPs.ConclusionsThe use of psychotropic and analgesic drugs was high and varied substantially between different NHs. Even if the use of more drugs, opioids and psychotropic drugs was associated with DRPs, no difference was found in DRPs between the NHs with highest vs. lowest drug use.

Highlights

Residents at nursing homes (NHs) are at particular risk for drug related harm
Based on a cross sectional study in 41 NHs with 2465 residents [21], we aim to describe the variation between the NHs with respect to their drug use and corresponding variation in Drug-related problems (DRP), and to explore the associations between the two
Seven NHs had only Regular unit (RU), three NHs had only Special care unit for dementia (SCU) and 31 NHs had both types of bed units

Summary

Introduction

Regular medication reviews using explicit criteria for pharmacological inappropriateness and classification of drug related problems (DRPs) have recently been introduced as measures to improve the quality of medication use and for making the treatment more uniform across different institutions. To explore if increased attention towards more appropriate drug treatment in NHs have led to more uniform treatment, we have analyzed variations between different nursing homes’ drug use and DRPs. Residents in nursing homes (NHs) are often old and due to multimorbidity and frailty have short life expectancies and extensive needs for assistance for carrying out activities of daily living. The widespread use of antipsychotic drugs, benzodiazepines and antidepressants for BPSD is largely inappropriate, because they are commonly used instead of recommended non-pharmacological interventions [9, 10], they have limited effects and their use is associated with an increased risk for adverse drug reactions like delirium, impaired balance and falls and stroke [11]. Substantial variations in drug use have previously been reported among residents in otherwise similar NHs with comparable patient populations [12,13,14,15], even if located in the same geographical area [13], and that institutions with high prevalence of drug use tend to use higher dosages [14], probably due to different prescription cultures and organizational factors at the institutions

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