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Patient focused drug surveillance of elderly patients in nursing homes
Family Medicine Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Department of Medicine, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences. Örebro County Council Medical Products Committee, Örebro, Sweden.ORCID iD: 0000-0001-8828-9299
2010 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 19, no 2, p. 150-157Article in journal (Refereed) Published
Abstract [en]

Purpose To examine whether patient focused drug surveillance was associated with a higher quality of drug treatment at nursing homes.

Methods An intervention study in four nursing homes in Sweden and four other nursing homes served as controls. At the intervention nursing homes physicians focused on patients' health status as a baseline for further ongoing medication. The outcomes were mortality, health care consumption, and number of drugs, health status and evaluations as parameters for "quality of drug treatment".

Results There were no significant differences in mortality rates. Healthcare consumption and polypharmacy were extensive in both groups. There was a significant reduction of number of drugs used per patient at the intervention homes during the study (p < 0.05). Monitoring and evaluation of the effects of medications were significantly more frequent at the intervention homes (p < 0.01).

Conclusions The intervention resulted in significant positive results in relation to "quality of drug treatment", a shift in health care utilization with concomitant use of fewer drugs. The study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. Copyright (C) 2009 John Wiley & Sons, Ltd.

Place, publisher, year, edition, pages
2010. Vol. 19, no 2, p. 150-157
Keywords [en]
elderly, polypharmacy, drug evaluation, monitoring
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-13003DOI: 10.1002/pds.1891ISI: 000274957000006OAI: oai:DiVA.org:oru-13003DiVA, id: diva2:382835
Available from: 2011-01-03 Created: 2011-01-03 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Rational drug treatment in the elderly: "To treat or not to treat"
Open this publication in new window or tab >>Rational drug treatment in the elderly: "To treat or not to treat"
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to examine the effect of interventions on the usage of inappropriate and hazardous multi-medication in the elderly ≥75 years with ≥5 drugs.

Methods: Paper I describes a cluster randomization of nursing homes, the outcomes were; number of drugs, health status and evaluations. A randomized controlled trial concerning elderly in ordinary homes was performed in paper II and the outcomes were; EQ-5D index, EQ VAS and prescription quality. In paper III a cohort study was carried out and the outcomes were; medication appropriateness index, EQ-5D index and EQ VAS. In paper IV, registered nurses from the nursing homes study were interviewed in a descriptive study with a qualitative approach.

Results:There was a significant reduction of number of drugs used per patient at the intervention nursing homes (p<0.05). Monitoring and evaluation of medications were significantly more frequent at the intervention homes (p<0.01). The registered nurses at the nursing homes described a self-made role in their profession and the leadership was not at sight. Drug treatment seems to be a passive process without own reflection. Extreme polypharmacy was persistent in all three groups of elderly living in ordinary homes and there was an unchanged frequency of drug-risk indicators. In the cohort study a lower medication quality was shown to be associated with a lower quality of life. EQ-5D index was statistically significantly different among the groups as was EQ VAS.

Conclusion: The nursing home study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. More attention must be focused on the complexity of the nursing process; medication management must be promoted in teamwork with the physician. The resistance to change prescriptions in accordance with the intervention underlines the need of new strategies for improving prescription quality. Since medication quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment in shared decision with the patient.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 84
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 64
Keywords
Elderly, polypharmacy, drug evaluation, nursing process, monitoring, inappropriate prescribing, quality of life, patient participation
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-20618 (URN)978-91-7668-843-4 (ISBN)
Public defence
2012-02-03, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-12-22 Created: 2011-12-22 Last updated: 2017-10-17Bibliographically approved

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Nordin Olsson, IngerEngfeldt, Peter

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