Document Detail


Potentially Inappropriate Drug Prescribing and Associated Factors in Nursing Homes.
MedLine Citation:
PMID:  25284165     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
IMPORTANCE: Polymedication is frequent in nursing home (NH) residents. This increases the risk of potentially inappropriate drug prescribing (PIDP), which can lead to adverse drug events, such as falls and hospitalization.
OBJECTIVE: To identify PIDP in NH residents and to investigate subject-related and NH structural and organizational factors associated with PIDP.
DESIGN: Cross-sectional study.
SETTING: A total of 175 NHs in Midi-Pyrénées region, South-Western France.
PARTICIPANTS: A total of 974 subjects randomly selected from the 6275 NH residents participating in the IQUARE study.
EXPOSURE: Patients with PIDP.
MAIN OUTCOMES AND MEASURES: PIDP was the main outcome measure. It was defined using a specific indicator, based on the Summary of Product Characteristics, on the Laroche list, and on residents' clinical data. PIDP was defined as the presence of at least 1 of the following criteria: (1) drug with an unfavorable benefit-to-risk ratio; (2) drug with questionable efficacy according to the Laroche list; (3) absolute contraindication; (4) significant drug-drug interaction. Associated factors were identified by using multivariable logistic regression models.
RESULTS: Among the 974 residents included, 71% had PIDP. PIDP was more frequent in patients without dementia, with several comorbidities and taking multiple medications. In the multivariable analysis, age (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.03) and Charlson Comorbidity Index (CCI; P = .003, CCI = 1 versus 0: OR1/0 1.22; 95% CI 0.85-1.74, CCI ≥ 2 versus 0: OR2/0 1.72; 95% CI 1.23-2.41) were associated with an increased likelihood of PIDP. By contrast, dementia was associated with a lower likelihood of PIDP (OR 0.70; 95% CI 0.53-0.94). Among NH structural and organizational characteristics, the access to psychiatric advice and/or to hospitalization in a psychiatric unit (OR 1.36; 95% CI 1.02-1.82) and the presence of a reevaluation of drug prescriptions (OR 1.45; 95% CI 1.07-1.96) were associated with an increased likelihood of PIDP.
CONCLUSIONS AND RELEVANCE: Our work suggests that some NH characteristics are associated with an increased likelihood of PIDP. Gaining a better understanding of the factors influencing PIDP, especially structural and organizational NH factors, can help to determine the interventions that should be implemented.
Authors:
Charlène Cool; Philippe Cestac; Charlotte Laborde; Cécile Lebaudy; Laure Rouch; Benoit Lepage; Bruno Vellas; Philipe de Souto Barreto; Yves Rolland; Maryse Lapeyre-Mestre
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-2
Journal Detail:
Title:  Journal of the American Medical Directors Association     Volume:  -     ISSN:  1538-9375     ISO Abbreviation:  J Am Med Dir Assoc     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-10-6     Completed Date:  -     Revised Date:  2014-10-7    
Medline Journal Info:
Nlm Unique ID:  100893243     Medline TA:  J Am Med Dir Assoc     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
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