INAPPROPRIATE MEDICATION PRESCRIBING IN SKILLED-NURSING FACILITIES

被引:209
作者
BEERS, MH
OUSLANDER, JG
FINGOLD, SF
MORGENSTERN, H
REUBEN, DB
ROGERS, W
ZEFFREN, MJ
BECK, JC
机构
[1] UNIV CALIF LOS ANGELES, SCH MED, CTR HLTH SCI, MULTICAMPUS DIV GERIATR & GERONTOL, LOS ANGELES, CA 90024 USA
[2] UNIV CALIF LOS ANGELES, SCH PUBL HLTH, DEPT EPIDEMIOL, LOS ANGELES, CA 90024 USA
[3] RAND CORP, SANTA MONICA, CA 90403 USA
[4] PATIENT CARE PHARM, LOS ANGELES, CA 90045 USA
关键词
NURSING HOMES; PRESCRIPTIONS; DRUG; DOSE-RESPONSE RELATIONSHIP; ACTIVITIES OF DAILY LIVING; QUALITY OF LIFE;
D O I
10.7326/0003-4819-117-8-684
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To quantity the appropriateness of medication prescriptions in nursing home residents. Design: Prospective, cohort study. Setting: Twelve nursing homes in the greater Los Angeles area. Participants: A total of 1106 nursing home residents. Main Outcome Measures: The appropriateness of medication prescriptions was evaluated using explicit criteria developed through consensus by 13 experts from the United States and Canada. These experts identified 19 drugs that should generally be avoided and 11 doses, frequencies, or durations of use of specific drugs that generally should not be exceeded. Results: Based on the consensus criteria, 40% of residents received at least one inappropriate medication order, and 10% received two or more inappropriate medication orders concurrently; 7% of all prescriptions were inappropriate. Physicians prescribed a greater number of inappropriate medications for female residents. Regression analysis, corrected for clustering effects within facilities, showed that a greater number of inappropriate medication prescriptions were ordered in larger nursing homes. Inappropriate prescriptions were not related to the proportion of Medicaid (Medi-Cal) residents or the number of physicians practicing in the homes. Conclusions: Inappropriate medication prescribing in nursing homes is common. Female residents and residents of large nursing homes are at the greatest risk for receiving an inappropriate prescription.
引用
收藏
页码:684 / 689
页数:6
相关论文
共 22 条
[1]  
ABRAMS W B, 1985, Rational Drug Therapy, V19, P1
[2]  
ALBRICH JM, 1988, AMBULATORY MED LETT, P1
[3]   PSYCHOACTIVE MEDICATION USE IN INTERMEDIATE-CARE FACILITY RESIDENTS [J].
BEERS, M ;
AVORN, J ;
SOUMERAI, SB ;
EVERITT, DE ;
SHERMAN, DS ;
SALEM, S .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1988, 260 (20) :3016-3020
[4]  
BEERS MH, 1991, ARCH INTERN MED, V151, P1825
[5]   RISK-FACTORS IN GERIATRIC DRUG PRESCRIBING - A PRACTICAL GUIDE TO AVOIDING PROBLEMS [J].
BEERS, MH ;
OUSLANDER, JG .
DRUGS, 1989, 37 (01) :105-112
[6]  
BEERS MH, 1985, DRUGS, V19, P1
[7]   APPROPRIATENESS OF ACUTE MEDICAL-CARE FOR THE ELDERLY - AN ANALYSIS OF THE LITERATURE [J].
BROOK, RH ;
KAMBERG, CJ ;
MAYEROAKES, A ;
BEERS, MH ;
RAUBE, K ;
STEINER, A .
HEALTH POLICY, 1990, 14 (03) :225-242
[8]   OVERTREATING THE DEFICIENCY ANEMIAS [J].
CROSBY, WH .
ARCHIVES OF INTERNAL MEDICINE, 1986, 146 (04) :779-779
[9]  
DALKEY NC, 1967, P3704 RAND RAND CORP
[10]  
DAVIES DM, 1985, TXB ADVERSE DRUG REA, P241