Quality of Drug Use in Swedish Nursing Homes

Abstract

Objective: To assess the overall drug use in Swedish nursing homes or equivalent residential facilities, and changes in the quality of drug use that have occurred over a 3-year period.

Design and Setting: The nursing homes included in a 1995 intervention study were investigated again during the Spring of 1998. The previous intervention aimed at improving drug use through improved teamwork among physicians, pharmacists, nurses and nurses’ assistants. A total of 36 nursing homes participated in the follow-up, 18 of which received team training in order to conduct interventions regarding drug use in the 1995 study (team training homes). Eighteen did not receive team training and served here as control homes.

Participants: The sample consisted of 1549 long-term care residents with an average age of 84 years. 68% of the residents were female and 53% had a documented diagnosis of dementia. 10% had a disorder with a psychotic component and 21% were diagnosed with depression.

Measurements: Lists of each resident’s prescriptions were collected. In addition, data about resident and facility characteristics were collected from the charge nurses. Specific quality indicators based on published guidelines and recommendations were developed to measure drug appropriateness. Measures included the proportion of users of the 15 most prescribed drugs, as well as the proportion of residents prescribed less appropriate medications according to the quality indicators.

Results: The number of medications increased from an average of 8.0 to 8.8 per resident, but there was a decrease (23%) in the prescribing of antipsychotics to residents without documentation of a psychotic symptom. Furthermore, there was a decrease in the proportion of residents prescribed two or more drugs from the same therapeutic class of psychotropics. There was also a reduction in the prescription of non-recommended sedative-hypnotics (26%) and non-recommended anxiolytics (15%) in all nursing homes. In 1998, significantly lower proportions of residents in team training homes were prescribed (a) more than three drugs that could increase the risk of confusion, (b) non-recommended hypnotics, and (c) combinations of drugs that could lead to interactions, than were residents in the control homes.

Conclusion: The nursing homes that had received team training and served as intervention homes in the previous study still had a significantly higher quality of drug use with respect to three of the quality criteria. The study demonstrates that, although much still remains to be done to optimise drug use for the sick and elderly in nursing homes, quality assurance programmes with a multidisciplinary approach are effective and should be further developed and implemented.