Abstract
Introduction: We have previously reported sub optimal use of hypnotics in geriatric institutions. In the present study we examined the intervention by a pharmacist on the prescribing and administration of hypnotics in nursing homes. Thus a follow up study was performed in 5 nursing homes included in the previous study.Method: In the period between the two surveys the pharmacist provided drug information on the rational use of hypnotics, both written and verbal, to the staff of the institutions. Data on the administration of hypnotics was obtained from the Cardex system in the institutions. Data were compared to a control group in other nursing homes, where no intervention was carried out.Results: Although the population was older in 2000 than in 1995, the proportion of patients using hypnotics (24%) was similar. Use of benzodiazepines was reduced from 81% to 40%, use of long acting benzodiazepines was reduced from 62% to 22%, and use of short‐acting hypnotics (zopiclone, zolpidem) increased from 9% to 53%. Furthermore, hypnotics administered before 9 p.m. were reduced from 40% to 14%, and the time of administration showed less variation than before. In the control population we also observed the use of short acting hypnotics in favour of benzodiazepines, similar to the results in the 5 institutions. However, in this population a significantly higher proportion of patients used hypnotics, used more than 1 hypnotic and the hypnotics were administered earlier in the evening.Conclusion: The results demonstrate an important effect of written and verbal drug information provided by a pharmacist to improve the prescribing and administration on the use of hypnotics in nursing homes.
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REFERENCES
Oates JA, Wood AJJ, Gillin JC, Byerley WF. The diagnosis and management of insomnia. New Engl J Med 1990;22:239-48.
Bachman DL. Sleep disorders with aging: Evaluation and treatment. Geriatrics 1992;47:53-61.
Costa e Silva JA, Chase M, Sartorius N, Roth T. Special report from a symposium held by the World Health Organization and the World Federation of Sleep Research Societies: An overview of insomnias and related disorders-recognition, epidemiology, and rational management. Sleep 1996;19:412-6.
Seppala M, Rajala T, Sourander L. Subjective evaluation of sleep and the use of hypnotics in nursing homes. Aging (Milano) 1993;5:199-205.
van Dijk KN, de Vries CS, van den Berg PB, Brouwers JR, de Jong-van den Berg LT. Drug utilisation in Dutch nursing homes. Eur J Clin Pharmacol 2000;55:765-71.
Opedal K, Schjø tt J, Eide E. Use of hynotics among patients in geriatric institutions. Int J Geriat Psychiatry 1998;13:846-51.
Avorn J, Gurwitz JH. Drug use in the nursing home. Ann Intern Med 1995;123:195-204.
Monane M, Avorn J. Medications and falls. Causation, correlation, and prevention. Clin Geriatr Med 1996;12:847-858.
Soumerai SB, Avorn J. Principles of educational outreach (“academic detailing”) to improve clinical decision making. JAMA 1990;263:549-56.
Avorn J, Soumerai SB, Everitt DE, Ross-Degnan D, Beers MH, Sherman D, et al. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med 1992;327:168-73.
Ray WA, Taylor JA, Meador KG, Lichtenstein MJ, Griffin MR, Fought R, et al. Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. Arch Intern Med 1993;153:713-21.
Lin EHB, Katon WJ, Simon GE, Von Korff M, Bush TM, Rutter CM, et al. Achieving guidelines for the treatment of depression in primary care: is physician education enough? Med Care 1997];35:831-42.
Zwar NA, Wolk J, Gordon JJ, Sanson-Fisher RW. Benzodiazepine prescribing by GP registrars. A trial of educational outreach. Aust Fam Physician 2000;29:1104-7.
Thornley SM, Carmichael JM, Bryg RJ. Effect of clinical pharmacy input on physician prescribing habits in the nursing home care unit. Hosp Pharm 1992;27:616-21.
McGettigan P, Golden J, Fryer J, Chan R, Feely J. Prescribers prefer people: The sources of information used by doctors for prescribing suggest that the medium is more important than the message. Br J Clin Pharmacol 2001;5:184-9.
Gurwitz JH, Field TS, Avorn J, McCormick D, Jain S, Eckler M, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med 2000;109:87-94.
Flamer HE. Sleep problems. Med J Austr 1995;162:603-607.
Everitt _DE, Avorn J, Baker MW. Clinical decision-making in the evaluation and treatment of insomnia. Am J Med 1990;89:357-62.
Lader M. Hypnotics in the elderly. Int J Geriatr Psychopharmacol 1997;1:10-14.
Nishino S, Mignot E. Drug treatment of patients with insomnia and excessive daytime sleepiness. Clin Pharmacokinet 1999;37:305-30.
Noble S, Langtry HD, Lamb HM. Zopiclone. An update of its pharmacology, clinical efficacy and tolerability in the treatment of insomnia. Drugs 1998;55:277-302.
Holm KJ, Goa KL. Zolpidem: an update of its pharmacology, therapeutic efficacy and tolerability in the treatment of insomnia. Drugs 2000;59:865-89.
Hemmeter U, Muller M, Bischof R, Annen B, Holsboer-Trachsler E. Effect of zopiclone and temazepam on sleep EEG parameters, psychomotor and memory functions in healthy elderly volunteers. Psychopharmacology (Berl) 2000;147:384-96.
Ayonrinde O, Sampson E. Physical dependence on zopiclone. Risk of dependence may be greater in those with dependent personalities. BMJ 1998;317:146.
Ravishankar A, Carnwath T. Zolpidem tolerance and dependence-Two case reports. J Psychopharmacol 1998;12:103-4.
Ray WA, Thapa PB, Gideon P. Benzodiazepines and the risk of falls in nursing home residents. J Am Geriatr Soc 2000; 48:682-5.
Nakra BR, Grossberg GT, Peck B. Insomnia in the elderly. Am Fam Phys 1991;43:477-83.
Schjø tt J, Opedal K, Rutledal JE. A survey of hypnotic use in geriatric institutions in Sogn og Fjordane, Norway. Aging Clin Exp Res 1999;11:50-5.
Norwegian Medicines Control Authority. Treatment of insomnia. The Norwegian Drug Bulletin 2000;8:5-16. 231 Volume 23 No. 6 2001 Pharmacy World & Science
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Eide, E., Schjøtt, J. Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes. Pharm World Sci 23, 227–231 (2001). https://doi.org/10.1023/A:1015142211348
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DOI: https://doi.org/10.1023/A:1015142211348