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Abstract
Objective: To describe the overall drug use in Swedish nursing homes and to comment on the impact of regular multidisciplinary team interventions on the quantity of inappropriate medications.
Design and Setting: This randomised, controlled trial was carried out in a sample of 33 nursing homes, 15 experimental homes and 18 control homes, representing 5% of all Swedish nursing homes.
Participants: The sample consisted of 1854 nursing home residents with an average age of 83 years. 70% of the residents were female and 42% had a documented diagnosis of dementia. An additional 5% had a psychotic disorder and 7% had a diagnosis of depression.
Measurements: Lists of each resident’s prescriptions were collected 1 month before and 1 month after the 12-month intervention. Measures included the proportion of residents receiving any particular drug. The number of drugs classified by guidelines as inappropriate was also measured before and after the intervention period.
Results: The nursing home residents were prescribed on average 7.7 medications, the majority on a regular basis. The most frequently prescribed group of drugs was laxatives, followed by psychotropic agents and cardiovascular drugs. Some groups of drugs decreased in the intervention homes.
Conclusion: Extensive and somewhat inappropriate drug use in Swedish nursing homes is a significant and serious problem. Careful monitoring is necessary to ensure well tolerated drug therapy in this frail population. Neither written information from the Medical Products Agency, nor the campaign in the pharmacies alone had an impact on drug use in Swedish nursing homes. Multidisciplinary team discussions contributed to improved drug use, but more research is needed to understand the mechanisms behind this finding.
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References
SCB. Statistisk årsbok. Stockholm: Statistiska Centralbyrån, 1996
Schmidt IK, Claesson CB, Westerholm B, et al. Physician and staff assessments of drug interventions and outcomes in Swedish nursing homes. Ann Pharmacother 1998; 32: 27–32
Sandman PO, Wallblom A. Characteristics of the demented living in different settings in Sweden. Acta Neurol Scand Suppl. 1996; 168: 96–100
Nordenstam I, Wennberg M, Kristoferson K. Svensk läkemedels-statistik 1995. Stockholm: Apoteksbolaget, 1996
Andersson M. Drugs prescribed for elderly patients in nursing homes or under medical home care. Compr Gerontol [A] 1989; Suppl. A+B 3: 8–15
Rȼrvik FB, Laakke K. Drug prescribing in nursing homes andhomes for the aged. J Norweigen Med Assoc 1990; 110: 1335–8
Dehlin O, Franzén M. Prevalence of dementia syndromes in persons living in homes for the elderly and in nursing homes in southern Sweden. Scand J Prim Health Care 1985; 3: 215–22
Avorn J, Dreyer P, Connelly K, et al. Use of psychoactive medication and the quality of care in rest homes. Findings and policy implications of statewide study. N Engl J Med 1989; 320: 227–32
Nolan L, O’Malley K. The need for a more rational approach to drug prescribing forelderlypeoplein nursing homes. Age Ageing 1989; 18: 52–6
Keltner NL, Folks DG. The omnibus budget reconciliation act: Impact on psychotropic drug use in long-term care facilities. Perspect Psychiatr Care 1995; 31: 30–3
Beers MH, Ouslander JG, Fingold SF, et al. Inappropriate medication prescribing in skilled-nursing facilties. Ann Intern Med 1992; 117: 684–9
Kane RL, Williams CC, Kane RA. Restraining restraints: Changes in a standard of care. Annu Rev Public Health 1993; 14: 545–84
Laucka PV, Hoffman NB. Decreasing medication use in a nursinghome patient-care unit. Am J Hosp Pharm 1992; 49: 96–9
Rovner BW, Edelman BA, Cox MP, et al. The impact of antipsychotic drug regulations on psychotropic prescribing practices in nursing homes. Am J Psychiatry 1992; 149: 1390–2
Shorr RI, Fought RL, Ray WA. Changes in antipsychotic drug use in nursing homes during implementation of the OBRA-87 regulations. JAMA 1994; 271: 358–62
Medical Products Agency & The Norwegian Medicines Control Authority. Treatment of mental conditions in patients with dementia. Workshop held in Uppsala, Sweden 1994 Mar. 1995: 1: 9-10
Schmidt IK, Claesson CB, Westerholm B, et al. The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes. JAGS 1998; 46: 77–82
Avorn J, Gurwitz JH. Drug use in the nursing home. Ann Intern Med 1995; 123:195–204
Avorn J, Soumerai SB, Everitt DE, et al. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. Consultant Pharmacist 1993; 8: 40–7
Gurwitz JH, Soumerai SB, Avorn J. Improving medication prescribing and utilization in the nursing home. J Am Geriatr Soc 1990; 38: 542–52
Soumerai SB, Avorn J. Predictors of physician prescribing change in an educational experiment to improve medication use. Med Care 1987; 25: 210–22
Lindberg J, Claesson CB, Cornelius C, et al. Medicine use in the elderly. A population study in an urban area of Sweden. Drug Invest 1994; 8: 241–53
Arling G, Ryther B J, Collins T, et al. Mental illness and psychotropic medication use in the nursing home. J Aging Health 1991; 3: 455–72
Beers M, Avorn J. Psychactive medication use in intermediate-care facility residents. JAMA 1988; 260: 3016–20
Buck JA. Psychotropic drug practice in nursing homes. J Am Geriatr Soc 1988; 36: 409–18
Everitt DE, Fields DR, Soumerai SS, et al. Resident behavior and staff distress in the nursing home. J Am Geriatr Soc 1991; 39: 792–8
Burns BJ, Kamerow DB. Psychotropic drug prescriptions for nursing home residents. J Fam Pract 1988; 26: 155–60
Beardsley RS. Prescribing of psychotropics in elderly nursing homes patients. J Am Geriatr Soc 1989; 37: 327–30
Snowdon J, Vaughan R, Miller R, et al. Psychotropic drug use in Sydney nursing homes. Med J Aust 1995; 163: 70–2
Ingman SR, Lawson IR, Pierpaoli PG, et al. A survey of the prescribing and administartion of drugs in a long-term care institution for the elderly. J Am Geriatr Soc 1975; 23: 309–16
Ray WA, Federspeil CF, Schaffner W. A study of antipsychotic drug use in nursing homes: epidemiological evidence suggesting misuse. Am J Public Health 1980; 70: 485–91
Segal JL, Thompson JF, Floyd RA. Drug utilization and prescribing patterns in a skilled nursing facility: The need for a rational approach to therapeutics. J Am Geriatr Soc 1979; 27: 117–22
Billig N, Cohen-Mansfield J, Lipson S. Pharmacological treatment of agitation in a nursing home. J Am Geriatr Soc 1991; 39: 1002–5
Sandberg AM. Use of four classes of psychoactive drugs in long-term care facilities. Consultant Pharmacist 1993; 8: 1377–81
Bassa R, Law J, Goldberg LA. Hypnotics useage among elderly patients in homes and hospital wards in Salford. Pharm J 1994; 252: 474–6
Gilleard CJ, Smits C, Morgan K. Changes in hypnoic usage in residential homes for the elderly: a longitudinal study. Arch Gerontol Geriatr 1984; 3: 223–8
Flood D. Hugs not drugs — an alternative management tool. Lamp 1994; 51: 24
Lipson S. The restraint-free approach to bahavior problems in the nursing home. Md Med J 1994; 43(1): 155–7
Sinett PF. Restless patients in nursing homes. What is the role of drug therapy? Drugs Aging 1994; 4: 443–8
LeSage J. Polypharmacy in geriatric patients. Nurs Clin North Am 1991; 26: 273–90
GAO (General Accounting Office) report: prescription drugs and the elderly. Washington: GAO, 1995
Manasse HR. Medication use in an imperfect world: drug mis adventuring as an issue of policy. Pt 1. Am J Hosp Pharm 1989; 46: 929–44
Beard K. Adverse reactions as a cause of hospital admission in the aged. Drugs Aging 1992; 2: 356–67
Avorn J, Chen M, Hartley R. Scientific versus commercial ources of influence on prescribing behavior of physicians. Am J Med 1982; 73: 4–8
Gulmann NC. Demens og etik. Fra psykofarmaka til livstestamente. Nord Med 1993; 108: 266–8
Harrington C, Tompkins C, Curtis M, et al. Psychotropic drug use in long-term care facilities: a review of the literature. Gerontologist 1992; 32: 822–33
Schwartz RK, Soumerai SB, Avorn J. Physician motivations for non-scientific prescribing. Soc Sci Med 1989; 28: 577–82
Svarstad B, Mount J. Nursing home resources and tranquilizer use among the institionalized elderly. J Am Geriatr Soc 1991; 39: 869–75
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Claesson, C.B., Schmidt, I.K. Drug Use in Swedish Nursing Homes. Clin. Drug Investig. 16, 441–452 (1998). https://doi.org/10.2165/00044011-199816060-00004
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DOI: https://doi.org/10.2165/00044011-199816060-00004