Journal of the American Medical Directors Association
JAMDA OnlineOriginal StudyPotentially Inappropriate Drug Prescribing and Associated Factors in Nursing Homes
Section snippets
Data Source
The IQUARE study (Impact d'une demarche QUAlité sur l’évolution des pratiques et le déclin fonctionnel des Résidents en EHPAD) is a multicentric individually tailored controlled trial performed in NHs in the Midi-Pyrénées area, South-Western, France (trial registration number: NCT01703689). IQUARE's research protocol has been fully described elsewhere25 and several analyses related to specific drug use have been previously published.26, 27, 28 IQUARE followed the principles of the Declaration
Characteristics of the Study Population (Residents) and NHs
From the 1000 residents randomly selected, 26 were excluded because of end of life. Resident characteristics and NH characteristics (aggregated at the resident level) according to PIDP are presented respectively in Table 1, Table 2.
Outcome Measures
Table 3 presents the prevalence of PIDP and other potential DRPs. Among the 974 residents included, 70.6% (n = 688) had PIDP: 65.3% (n = 656) of residents had at least 1 drug with an unfavorable benefit-to-risk ratio (21.6% according to the Laroche list,22 and 58.2%
Discussion
This study showed that the likelihood of PIDP was not related to NH characteristics, except for access to psychiatric advice and/or to hospitalization in a psychiatric unit. Prescribing drugs with an unfavorable benefit-to-risk ratio was less frequent in patients living in an NH with a special care unit.
To the best of our knowledge, few studies have investigated structural and organizational characteristics of NHs on the quality of drug prescribing, irrespective of the individual
Conclusion
This study provides the first multilevel findings of prescribing drugs with an unfavorable benefit-to-risk ratio among NH residents in France. Structural and organizational factors in NHs would be easier to change than individual characteristics of residents. Gaining a better understanding of the factors influencing PIDP can help to determine the interventions that should be implemented.
Acknowledgments
We thank all the people who rendered this research possible, particularly coordinating physicians, coordinating nurses, and directors of participating nursing homes. We also thank the helpful participation of Flavie Boyé, PharmD, Fiona Chautant, PharmD, Laurie Boccanfuso, PharmD, and Audrey Bigot, who conducted the Drug Utilization Review. The contributors received no financial compensation. We acknowledge Paul McCambridge for editing the final version of the manuscript.
References (56)
- et al.
Identification of the main domains for quality of care and clinical research in nursing homes
J Nutr Health Aging
(2011) - et al.
Self-reported medication use in community-residing older adults: A pilot study
Am J Geriatr Pharmacother
(2005) - et al.
The incidence of adverse drug events in two large academic long-term care facilities
Am J Med
(2005) - et al.
Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents
Am J Geriatr Pharmacother
(2006) - et al.
Challenge of changing nursing home prescribing culture
Am J Geriatr Pharmacother
(2012) - et al.
Exploring variation in rates of polypharmacy across long term care homes
J Am Med Dir Assoc
(2012) - et al.
Predictors of hospitalization in Italian nursing home residents: The U.L.I.S.S.E. project
J Am Med Dir Assoc
(2012) - et al.
The challenge of managing drug interactions in elderly people
Lancet
(2007) - et al.
Appropriate prescribing in elderly people: How well can it be measured and optimised?
Lancet
(2007) - et al.
Potentially inappropriate prescribing before and after nursing home admission among patients with and without dementia
Am J Geriatr Pharmacother
(2005)
STOPP & START criteria: A new approach to detecting potentially inappropriate prescribing in old age
Eur Geriatr Med
A multicentric individually-tailored controlled trial of education and professional support to nursing home staff: Research protocol and baseline data of the IQUARE study
J Nutr Health Aging
Indicators of benzodiazepine use in nursing home residents in France: A cross-sectional study
J Am Med Dir Assoc
Potential underuse of analgesics for recognized pain in nursing home residents with dementia: A cross-sectional study
Pain
Prevalence and associations of the use of proton-pump inhibitors in nursing homes: A cross-sectional study
J Am Med Dir Assoc
Descriptive study of nursing home residents from the REHPA network
J Nutr Health Aging
Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: Interventional study in 150 acutely ill elderly patients with mental and somatic comorbid conditions
J Am Med Dir Assoc
Antipsychotic drug use since the FDA black box warning: Survey of nursing home policies
J Am Med Dir Assoc
Trends in use of antipsychotics in elderly patients with dementia: Impact of national safety warnings
Eur Neuropsychopharmacol
Risk factors for aspiration pneumonia in frail older people: A systematic literature review
J Am Med Dir Assoc
Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts
Arch Intern Med
Medication as a risk factor for falls: Critical systematic review
J Gerontol A Biol Sci Med Sci
Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: Addressing polypharmacy
Arch Intern Med
Inappropriate prescribing in the older population: Need for new criteria
Age Ageing
Inappropriate prescribing for the elderly: Beers criteria-based review
Ann Pharmacother
Use of potentially inappropriate drugs in nursing homes
Pharmacotherapy
Potentially inappropriate medication prescriptions among elderly nursing home residents: Their scope and associated resident and facility characteristics
Health Serv Res
Evaluation of nationally mandated drug use reviews to improve patient safety in nursing homes: A natural experiment
J Am Geriatr Soc
Cited by (51)
Potentially Inappropriate Prescribing in Long-Term Care and its Relationship With Probable Delirium
2024, Journal of the American Medical Directors AssociationThe MGPIDP-L project: Potentially inappropriate drug prescribing and its associated factors
2023, Archives of Gerontology and GeriatricsEffect of an Educational and Organizational Intervention on Pain in Nursing Home Residents: A Nonrandomized Controlled Trial
2018, Journal of the American Medical Directors AssociationCitation Excerpt :Details of the IQUARE's research protocol, participants, and procedures have been described previously.23 Several other outcomes have been investigated from this data set.5,24–28 In particular, the intervention was found to be associated with a 48.9% increase in the prevalence of pain assessment using a standardized scale in residents complaining of pain or at the end of life.26
Potentially Inappropriate Prescribing in Belgian Nursing Homes: Prevalence and Associated Factors
2018, Journal of the American Medical Directors AssociationCitation Excerpt :With regard to NHR characteristics associated with PIMs, not surprisingly, a greater number of medications has been consistently identified as the strongest determinant of PIM use in the NH setting15,20–27 and across settings11; this is consistent with our results. Similarly, younger age has been associated with a higher rate of PIMs.11,22,23,28 The oldest residents may have fewer comorbidities, reflecting a “survival of the fittest.”22,23
Hospitalization Drug Regimen Changes in Geriatric Patients and Adherence to Modifications by General Practitioners in Primary Care
2018, Journal of Nutrition, Health and AgingPrediction of the Incidence of Falls and Deaths Among Elderly Nursing Home Residents: The SENIOR Study
2018, Journal of the American Medical Directors AssociationCitation Excerpt :The most frequent events causing the most consequences in nursing homes include falls and deaths.2,3 Also note that delirium, undernutrition, and polypharmacy are common in this setting.42,43 To adequately prevent these negative health outcomes, it is necessary to identify the risk factors.
The authors declare no conflicts of interest.
The IQUARE study was funded by the Regional Agency of Health from Midi-Pyrénées region (Agence Régionale de Santé – Midi-Pyrénées). The first author of this study (CC) was funded by the Ministry of Health as part of her pharmacy residency in “Innovation Pharmaceutique et Recherche” (IPR).