Review looks at approaches to improve drug prescribing in nursing home
Research Activities, January 2011, No. 365
Prescribing medications to nursing home residents is challenging. Many are on multiple drugs, increasing the potential for adverse drug events. Suboptimal prescribing may include the overuse of medications (e.g., sedatives), the underuse of medications (e.g., pain relievers), or the use of inappropriate drugs. Over the years, various interventions have been tried to improve prescribing practices in nursing homes. Recently, researchers conducted a review of randomized, controlled trials to see what interventions have been tried and their success rates. They found a variety of interventions with mixed results. The researchers analyzed the published medical literature from 1975 to 2009 to identify appropriate studies. In the end, 18 studies were selected for the review.
Of the 18 studies, 7 focused on various educational approaches to improve suboptimal prescribing practices. Another two studies measured the impact of computerized decision-support systems on adverse drug events and appropriate drug orders. Five studies looked at the role of the pharmacist and medication review activities. Two studies incorporated more than one intervention, and two studies used a multidisciplinary approach. Fifteen of the 18 studies (83.3 percent) resulted in a significant improvement for at least 1 or more dimensions of suboptimal prescribing. Three of the more recent studies were able to examine medication-related adverse patient events. Three of the four studies that focused on central nervous system medications showed a significant decrease in residents taking these medications after an educational intervention. Three trials on anti-infectives showed significant improvements in appropriate antibiotic prescribing after an educational or multifaceted intervention was implemented. The study was supported in part by the Agency for Healthcare Research and Quality (HS17695).
See "Interventions to improve suboptimal prescribing in nursing homes: A narrative review," by Zachary A. Marcum, Pharm.D., Steven M. Handler, M.D., M.S., Rollin Wright, M.D., M.P.H., and Joseph T. Hanlon, Pharm.D., M.S., in the June 2010 American Journal of Geriatric Pharmacotherapy 8(3), pp. 183-200.