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Prescribing Indicators for Evaluating Drug Use in Nursing Homes

Hospital Pharmacist, Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, the Netherlands

Lisa G Pont, PhD

Researcher, Drug Utilisation Studies, Department of Clinical Pharmacology, Groningen University Institute for Drug Exploration (GUIDE), University of Groningen, Groningen, the Netherlands

Corinne S de Vries, PhD

Senior Lecturer, Department of Pharmacoepidemiology, Postgraduate Medical School, University of Surrey, Guildford, United Kingdom

Maria Franken, MScPharm

Pharmacist, Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration (GUIDE)

Jacobus RBJ Brouwers, PhD

Professor, Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration (GUIDE)

Lolkje TW de Jong-van den Berg, PhD

Professor, Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration (GUIDE)

Reprints: Karen N van Dijk PhD, Department of Clinical Pharmacy, Medical Centre Leeuwarden, PO Box 888, 8901 BR Leeuwarden, the Netherlands, FAX 31 58 2866 606, E-mail Karen.van.Dijk{at}znb.nl

OBJECTIVE: To evaluate drug use in 2 Dutch nursing homes (254 residents) by developing and evaluating prescribing indicators based on pharmacy prescription data.

METHODS: We evaluated the prescribing of benzodiazepines, nonsteroidal antiinflammatory drugs (NSAIDs), ulcer-healing drugs, and diuretics. Prescribing indicators were used to identify prescribing that was potentially not in line with recommendations in national and regional prescribing guidelines. We used both descriptive indicators, such as the number and percentage of users, and indicators reflecting potentially suboptimal prescribing, such as use of drugs outside the regional drug formulary, use of >1 drug from the same drug class, and prescription of drug dosages above recommended values. When potentially suboptimal prescribing was found, we verified the findings by means of an interview with 1 of the prescribers.

RESULTS: The prescribing indicators we assessed were generally in agreement with national and regional guidelines. However, prescribing of NSAIDs without concomitant prescribing of gastroprotective drugs was found in a relatively high number of patients. After prescriber interview and patient chart review, it was found that some prescribing indicators, such as dosages above recommended values, were not always indicative for suboptimal prescribing.

CONCLUSIONS: This pilot study showed that prescribing indicators based solely on pharmacy prescription data can be a useful tool to evaluate drug prescribing. With some of these prescribing indicators, we identified cases of potentially suboptimal prescribing. However, with other indicators such as those based on drug dosages, we could not identify suboptimal prescribing, and clinical information from the prescriber was necessary to get insight into the appropriateness of prescribing.

Key Words: drug use, nursing homes, prescribing indicators

Published Online, June 16, 2003. www.theannals.com, DOI 10.1345/aph.1C073