A case study using the beers list criteria to compare prescribing by family practitioners and geriatric specialists in a rural nursing home

Todd Monroe, Michael Carter, Abby Parish, Todd Monroe, Michael Carter, Abby Parish

Abstract

Previous studies have concluded that inappropriate medications and/or too many medications can lead to adverse events in older adults. The Beers List of potentially inappropriate medications (PIMs) for use in the elderly was developed to help guide clinicians to safely prescribe medications. Moreover, in the United States, policies exist regulating the number of prescriptions nursing home residents may take. Few studies have compared family and geriatric providers' prescribing trends. The aim of this study was to compare prescribing by family and geriatric providers in a rural U.S. nursing home using a nonequivalent 2-group analysis design with data collected via retrospective chart audits (N=92). Nursing home residents in the nongeriatric provider group had fewer total comorbidities (U=p<.001) and were less likely to have congestive heart failure (χ2=p<.001), coronary artery disease (χ2=p<.001), and degenerative joint disease (χ2=p<.001). Despite this, on average, providers who were not geriatric trained prescribed twice as many drugs per patient (U=p<.001). The odds were significantly greater of being prescribed 9 or more drugs (odds ratio 13.15, 95% confidence interval 4.3-39.5) or being prescribed at least 1 PIM (odds ratio 6.25, 95% confidence interval 1.3-29.0) if the prescriber was not geriatric trained. The prevalence in this nursing home of receiving at least 1 PIM and polypharmacy were 36.9% and 72.8%, respectively. Promethazine accounted for 46.9% of all PIMs prescribed. Geriatric education appears to have influenced prescribing patterns at this facility, with geriatric-trained providers adhering more closely to evidence-based guidelines for older patients. As geriatric educational content is incorporated into nongeriatric specialty areas, pharmacology and prescribing competencies should be an area of ongoing focus for educators.

Copyright © 2011 Mosby, Inc. All rights reserved.

References

    1. Beers M, Ouslander J, Rollinger I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991; 151:1825–32.
    1. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts [corrected] [published erratum appears in Arch Intern Med 2004;164:298]. Arch Intern Med 2003;163:2716–24.
    1. Bergman A, Olsson J, Carlsten A, et al. Evaluation of the quality of drug therapy among elderly patients in nursing homes. Scand J Primary Health Care 2007;25:9–14.
    1. Koopmans R, van Rossum J, van der Hoogen H, et al. Psychotropic use in a group of Dutch nursing home patients with dementia: many users, long-term use, but low doses. Pharm World Sci 1996;18:42–7.
    1. Fick DM, Mion LC, Beers MH, et al. Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health 2008;31:42–51.
    1. Ray WA, Griffin MR, Schaffner W, et al. Psychotropic drug use and the risk of hip fracture. N Engl J Med 1987; 316:363–9.
    1. Lau DT, Kasper JD, Potter DEB, et al. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005;165:68–74.
    1. Terrell K, Heard K, Miller D. Prescribing to older ED patients. Am J Emerg Med 2006;24:468–78.
    1. McCance KL, Huether SE, eds. Pathophysiology: the biologic basis for disease in adults and children. 5th ed St. Louis, MO: Elsevier Mosby; 2006.
    1. American Health Care Association. The Long Term Care Survey. Revised ed. Washington, DC: American Health Care Association; 2006.
    1. Nguyen J, Fouts M, Kotabe S, et al. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006;4:36–41.
    1. Gurwitz J Polypharmacy: a new paradigm for quality drug therapy in the elderly? Arch Intern Med 2004;164: 1957–9.
    1. Crigger N, Holcomb L. Improving nurse practitioner practice through rational prescribing. Nurse Pract 2008;4: 120–5.
    1. Spinewine A, Schmader K, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007;370:173–84.
    1. Spooner J, Lapane K, Hume A, et al. Management of diabetes in long term care. J Clin Epidemiol 2001;54: 525–30.
    1. Gambassi G, Forman D, Lapane K, et al. Management of heart failure among very old individuals living in long-term care: has the voice of trials spread? Am Heart J 2000; 139:85–93.
    1. Lapane K, Fernandez H, Friedman J. Prevalence, clinical correlates and pharmacologic treatment of Parkinson’s disease patients living in long term care. Pharmacotherapy 1999;19:1321–7.
    1. Monroe T, Carter M. A retrospective pilot study of African American and Caucasian nursing home residents with cancer and dementia. J Pain Sympt Manage 2010;40: e1–3.
    1. Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med 2004; 164:305–12.
    1. Beers M, Fingold S, Ouslander J, et al. Characteristics and quality of prescribing by doctors practicing in nursing homes. J Am Geriatr Soc 1993;41:802–7.
    1. Larson E General internal medicine at the crossroads of prosperity and despair. Caring for patients with chronic disease in an aging society. Ann Intern Med 2001;134: 997–1000.
    1. Institute of Medicine. Retooling for an aging America: building the health care workforce, . Cited June 22, 2011.
    1. Bourbonniere M, Mezey M, Mitty EL, et al. Expanding the knowledge base of resident and facility outcomes of care delivered by advanced practice nurses in long-term care. Policy Politics Nurs Pract 2009;10:64–70.
    1. Lau DT, Kasper JD, Potter DEB, et al. Potentially inappropriate medication prescriptions among elderly nursing home residents: their scope and associated resident and facility characteristics. Health Serv Res 2004; 39:1257–76.
    1. Barton C, Sklenicka J, Sayegh P, et al. Contraindicated medication use among patients in a memory disorders clinic. Am J Geriatr Pharmacother 2008;6:147–52.
    1. Crigger N Pharmaceutical promotions and conflict of interest in nurse practitioner’s decision making: the undiscovered country. J Am Acad Nurse Pract 2005;17: 207–12.
    1. Futrell M, Melillo K. Gerontological nurse practitioners: implications for the future. J Geront Nurs 2005;31:19–24.
    1. Thornlow DK, Auerhahn C, Stanley J. A necessity nota luxury: preparing advanced practice nurses to care for older adults. J Prof Nurs 2006;22:116–22.
    1. Houde S, Melillo K. Caring for an aging population: review of policy initiatives. J Gerontol Nurs 2009;35:8–13.
    1. Scherer YK, Bruce SA, Montgomery CA, et al. A challenge in academia: meeting the healthcare needs of the growing number of older adults. J Am Acad Nurse Pract 2008;20: 471–6.
    1. Ryan C, O’Mahony D, Byrne S. Application of STOPP and START criteria: interrater reliability among pharmacists. Ann Pharmacother 2009;43: 1239–44.
    1. Beers M Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997;157:1531–6.

Source: PubMed

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