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drug use

Impact of Clinical Pharmacy on Drug Use in Nursing Homes

Impact of Clinical Pharmacy on Drug Use in Nursing Homes

Teaser: 

Professor Michael S Roberts, DSc
Julie Stokes, BPharm, PG
Dip Clin Hosp Pharm.
Department of Medicine,
University of Queensland,
Ipswich Road,
Buranda, Qld, Australia.

 

Introduction
One of the most professionally satisfying scenes we have observed while working in nursing homes is an older person regaining his or her dignity and independence after unnecessary drugs have been ceased. It is often easy to add medications to the drug regimen of older people1 to treat "new" conditions, some of which may in fact be the adverse effects of medications already prescribed. Drugs can cause subclinical diminution in function or their adverse effects can mimic almost any clinical syndrome.2 It has been shown that the risk and frequency of adverse drug outcomes increase with the number of drugs prescribed--some residents may be on up to 22 medicines at a given time3 and not all of these are needed. Some classes of medications, most notably psychoactive drugs, are of particular concern in nursing homes.4 In a prospective cohort study of 1106 nursing beds in 12 nursing homes in Los Angeles, Beers et al.5 suggested that 40% of the residents received at least one inappropriate medication order, 10% received two or more inappropriate medication orders concurrently, and 7% of all medications were inappropriate. A similar finding has been reported for the UK.

Drug Use in Nursing Homes: Legislating for Quality

Drug Use in Nursing Homes: Legislating for Quality

Teaser: 

Carmel M. Hughes, PhD
Senior Lecturer in Primary Care,
Pharmacy and National Primary Care Career Scientist,
School of Pharmacy,
The Queen's University of Belfast,
Northern Ireland.

Populations in the developed world are aging and the greatest demographic change is seen in those over the age of 80 years. Although it is a remarkable achievement in human survival, this demographic shift does present major challenges to health policy makers and providers. Health care for older people will need to be delivered at many levels--i.e., acute, intermediate, residential and home settings. The long-term care sector (nursing and residential homes) represents one area that can expect to face greater demands for delivery of quality services.

Quality of care and its assessment have become major concerns in most health markets in the developed world and long-term care is no exception. Perhaps the best system for assessing quality exists in the United States (US). This paper will provide an overview of the approach taken in US nursing homes with respect to drug use and contrast this with strategies in other countries.

Legislating for better care: the US situation
In 1983, the US Congress asked the Institute of Medicine to make recommendations for improving the quality of care in nursing homes.1 The report, published in 1986,2 revealed substantial evidence of appallingly bad care in many nursing homes in the USA.