Wiener klinische Wochenschrift

, Volume 125, Issue 7–8, pp 180–188 | Cite as

Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study

  • Eva Mann
  • Burkhard Haastert
  • Birgit Böhmdorfer
  • Thomas Frühwald
  • Bernhard Iglseder
  • Regina Roller-Wirnsberger
  • Gabriele Meyer
original article

Summary

Background

Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents’ characteristics.

Objective

The aim of our study was to analyse the prevalence and associations of PIP with residents’ and facilities’ characteristics.

Methods

We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents’ characteristics associated with PIP.

Results

Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 % (95 % CI 67.2–73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 %). The most often prescribed PIP were Prothipendyl (25.9 % residents), Lorazepam (14.5 %) and Diclofenac (6.1 %). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents.

Conclusions

Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.

Keywords

Inappropriate prescribing Nursing home Dementia Neuropsychiatric symptoms 

Prävalenz und Assoziationen von potentiell unangemessenen Verordnungen bei österreichischen Pflegeheimbewohnern: Sekundäranalyse einer Querschnittsstudie

Zusammenfassung

Grundlagen

Potentiell unangemessene Medikamentenverordnungen (potentially inappropriate prescriptions = „PIP“) sind eine bedeutende Ursache von unerwünschten Arzneimittel-assoziierten Wirkungen und führen zu vermehrten Kosten im Gesundheitssystem und vor allem bei Pflegeheimbewohnern zu erhöhter Morbidität und Spitalseinweisungen.

Wenig ist bisher bekannt über die Zusammenhänge zwischen PIP und den Charakteristika von Pflegeheimbewohnern.

Ziel

Ziel unserer Studie war es, die Prävalenz und Assoziationen von PIP mit den Charakteristika der Bewohner und Pflegeheime zu analysieren.

Methodik

Wir führten eine Sekundäranalyse einer Querschnittsstudie mit 48 von 50 möglichen Pflegeheimen und 1844 von 2005 möglichen Bewohnern eines definierten Bundeslandes in Österreich durch. Die Evaluierung der unangemessenen Verordnungen erfolgte anhand der „Österreichischen Liste der potentiell unangemessenen Arzneimittel“.

Cluster-adjustierte multivariate Regressionsanalyse wurde angewandt, um die Assoziationen von PIP mit Charakteristika der Institutionen und Bewohner auszuwerten.

Ergebnisse

Die mittlere cluster-adjustierte Häufigkeit von Heimbewohnern mit mindestens einem PIP war 70,3 % (95 % CI 67,2–73,4). Die Anzahl der Bewohner mit mindestens einer psychotropen PIP war 1,014 (55 %). Die häufigsten PIP waren Prothipendyl (25,9 % der Bewohner), Lorazepam (14,5 %) und Diclofenac (6,1 %). Multivariate Regressionsanalyse zeigte eine inverse Assoziation von PIP mit kognitiver Einschränkung und signifikant positive Assoziationen mit ständiger Unruhe und ständigem negativem Verhalten der Bewohner.

Die Assoziationen von PIP mit Alter und männlichem Geschlecht zeigten uneinheitliche Resultate. Keine signifikanten Assoziationen wurden zwischen PIP und dem Betreuungsverhältnis zwischen Pflegepersonen und Heimbewohnern gefunden.

Schlussfolgerungen

Unsere Studienresultate bestätigen, dass PIP bei Pflegeheimbewohnern weit verbreitet ist und zeigen, dass dringend effektive Strategien zur Reduktion von PIPs in Österreich notwendig sind. In anderen Ländern bereits durchgeführte erfolgreiche Initiativen und Interventionen könnten als Beispiele für Österreich herangezogen werden.

Schlüsselwörter

Unangebrachte Verschreibung Pflegewohnheim Demenz Neuropsychiatrische Symptome 

Notes

Conflict of interest

All authors declare that they have no conflict of interest relevant for the context of the study. No fees from pharmaceutical companies were received by Mann E., Böhmdorfer B., Frühwald T. and Meyer G. Honoraria for lectures received by Iglseder B. (Pfizer, EVER, Lundbeck, Sanofi-Aventis and Novartis) and Roller-Wirnsberger R. (Nutricia, Nestle, Pfizer, Novartis, Amgen, Madaus and Baxter).

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Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Eva Mann
    • 1
  • Burkhard Haastert
    • 2
  • Birgit Böhmdorfer
    • 3
    • 5
  • Thomas Frühwald
    • 4
  • Bernhard Iglseder
    • 5
  • Regina Roller-Wirnsberger
    • 6
  • Gabriele Meyer
    • 7
  1. 1.Institute of General Medicine, Family Medicine and Preventive MedicineParacelsus Medical UniversitySalzburgAustria
  2. 2.MediStatisticaNeuenradeGermany
  3. 3.Department of PharmacyVienna Hospital Association, Krankenhaus Hietzing mit neurologischem Zentrum RosenhügelViennaAustria
  4. 4.Department of Geriatric Acute CareVienna Hospital Association, Krankenhaus Hietzing mit neurologischem Zentrum RosenhügelViennaAustria
  5. 5.Department of Geriatric MedicineParacelsus Medical University, Christian-Doppler-KlinikSalzburgAustria
  6. 6.Department of Internal MedicineMedical University GrazGrazAustria
  7. 7.Faculty of Health, School of Nursing ScienceWitten/Herdecke UniversityWittenGermany

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