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Does Organisational Culture Influence Prescribing in Care Homes for Older People?

A New Direction for Research

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Abstract

Prescribing in care homes for older people has been the focus of much research and debate because of inappropriate drug choice and poor monitoring practices. In the US, this has led to the implementation of punitive and adversarial regulation that has sought to improve the quality of prescribing in this healthcare setting. This approach is unique to the US and has not been replicated elsewhere. The literature has revealed that there are limitations as to how much can be achieved with regulation that is externally imposed (an ‘external factor’). Other influences, which may be categorised as ‘internal factors’ operating within the care home (e.g. patient, physician and care-home characteristics), also affect prescribing. However, these internal and external factors do not appear to affect prescribing uniformly, and poor prescribing practices in care homes continue to be observed. One intangible factor that has received little attention in this area of healthcare is that of organisational culture. This factor has been linked to quality and performance within other health organisations. Consideration of organisational culture within care-home settings may help to understand what drives prescribing decisions in this particularly vulnerable patient group and thus provide new directions for future strategies to promote quality care.

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Acknowledgements

At the time of writing, Carmel M. Hughes was supported by a National Primary Care Career Scientist Award from the Research and Development Office, Northern Ireland, and Margaret Watson was funded by a Medical Research Council Special Training Fellowship in Health Services Research. No other sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article. The authors thank Dr Kathryn Mearns, University of Aberdeen, who contributed to the early development of this manuscript.

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Authors and Affiliations

  1. School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland

    Carmel M. Hughes

  2. Department of Community Health, Brown Medical School, Providence, Rhode Island, USA

    Kate Lapane

  3. Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, Scotland

    Margaret C. Watson

  4. School of Management, University of St Andrews, St Andrews, Scotland

    Huw T. O. Davies

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  1. Carmel M. Hughes
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Hughes, C.M., Lapane, K., Watson, M.C. et al. Does Organisational Culture Influence Prescribing in Care Homes for Older People?. Drugs Aging 24, 81–93 (2007). https://doi.org/10.2165/00002512-200724020-00001

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