Title

Improving medication prescribing and utilization in the nursing home.

UMMS Affiliation

Meyers Primary Care Institute; Department of Medicine

Date

5-1-1990

Document Type

Article

Medical Subject Headings

Aged; Decision Making; Documentation; Drug Prescriptions; Drug Therapy; Drug Utilization; Evaluation Studies as Topic; Homes for the Aged; Humans; Nursing Homes; Outcome and Process Assessment (Health Care); Physician's Practice Patterns

Disciplines

Health Services Research | Medicine and Health Sciences

Abstract

There is ample and compelling evidence to suggest that medications are frequently used inappropriately in the nursing home. The occurrence of avoidable adverse drug reactions is the most serious consequence of inappropriate prescribing; economic implications are also of interest. With increasing concern over the quality of care in nursing homes, and with the revision of regulations governing such care by the Health Care Financing Administration, it is important to consider the experience thus far in monitoring and improving drug use in nursing homes. A number of studies have investigated approaches designed to reduce inappropriate prescribing and drug utilization in this setting. In contrast to the wide range of approaches that have been evaluated and implemented in the hospital setting, interventions in the nursing home have centered primarily around consultant-pharmacist activities. Although these activities are now federally mandated in all nursing homes, there is little evidence from adequately controlled studies to document their impact or cost-effectiveness. By contrast, face-to-face educational interventions directed at physicians ("academic detailing") have been shown to be effective in improving prescribing for some medications. The prominent role played by the nursing staff in the utilization of many medications in the nursing home implies that an educational intervention excluding nursing staff would be insufficient to influence drug utilization positively in many situations (eg, psychoactive medications and laxatives). Future research efforts must pay greater attention to adequate study design considerations as well as to the clinical outcomes of such interventions and their cost-effectiveness.

Rights and Permissions

Citation: J Am Geriatr Soc. 1990 May;38(5):542-52.

Related Resources

Link to article in PubMed

PubMed ID

2185295

This document is currently not available here.

Share

COinS