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Reducing potentially inappropriate drug prescribing in nursing home residents: effectiveness of a geriatric intervention
Author(s) -
Cool Charlène,
Cestac Philippe,
McCambridge Cécile,
Rouch Laure,
Souto Barreto Philipe,
Rolland Yves,
LapeyreMestre Maryse
Publication year - 2018
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.13598
Subject(s) - medicine , odds ratio , contraindication , confidence interval , medical prescription , intervention (counseling) , logistic regression , emergency medicine , comorbidity , audit , family medicine , nursing , alternative medicine , management , pathology , economics
Aims Potentially inappropriate drug prescribing (PIDP) is frequent in nursing home (NH) residents. We aimed to investigate whether a geriatric intervention on quality of care reduced PIDP. Methods We performed an ancillary study within a multicentric individually‐tailored controlled trial (IQUARE trial). All NH received a baseline and 18‐month audit regarding drug prescriptions and other quality of care indicators. After the initial audit, NHs of the intervention group benefited of an in‐site intervention (geriatric education for NH staff) provided by a geriatrician from the closest hospital. The analysis included 629 residents of 159 NHs. The main outcome was PIDP, defined as the presence of at least one of the following criteria: (i) drug with an unfavourable benefit‐to‐risk ratio; (ii) with questionable efficacy; (iii) absolute contraindication; (iv) significant drug‐drug interaction. Multivariable multilevel logistic regression models were performed including residents and NH factors as confounders. Results PIDP was 65.2% (–3.6% from baseline) in the intervention group ( n = 339) and 69.9% (–2.3%) in the control group ( n = 290). The intervention significantly decreased PIDP [odds ratio (OR) = 0.63; 95% confidence interval 0.40–0.99], as a special care unit in NH (OR = 0.60; (0.42 to 0.85)), and a fall in the last 12 months (OR = 0.63; 0.44–0.90). Charlson Comorbidity Index [OR CCI = 1 vs . 0 = 1.38; 0.87–2.19, OR CCI ≥ 2 vs . 0 = 2.01; (1.31–3.08)] and psychiatric advice and/or hospitalization in a psychiatric unit (OR = 1.53; 1.07–2.18) increased the likelihood of PIDP. Conclusion This intervention based on a global geriatric education resulted in a significant reduction of PIDP at patient level.