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PHARMACOEPIDEMIOLOGY

Potentially Inappropriate Medication Use in Community Residential Care Facilities

Associate Professor, School of Pharmacy, University of Washington, Seattle, WA

Susan C Hedrick, PhD

Research Career Scientist, Health Services Research and Development Center of Excellence, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA; Professor, Department of Health Services, University of Washington

Ellen E Rhinard, PharmD

at time of writing, PharmD Student, School of Pharmacy, University of Washington; now, Specialty Pharmacy Resident in Family Practice, University of Washington Medical Center–Roosevelt, Seattle

Anne E Sales, MSN PhD

Research Scientist, Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System; Assistant Professor, Department of Health Services, University of Washington

Jean H Sullivan, BA

Program Director, Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System

Jane B Tornatore, PhD

at time of writing, Post-doctoral Fellow, Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System; Research Associate, Department of Health Services, University of Washington; now, Research Director, Screen Inc., Seattle

Michael P Curtis, PhD

at time of writing, Post-doctoral Fellow, Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System; now, Research Scientist II, Epidemiology and Evaluation Section, Maternal and Child Health Branch, California Department of Health Services, Sacramento, CA

Reprints: Shelly L Gray PharmD MS, School of Pharmacy, Box 357630, University of Washington, Seattle, WA 98195-7360, FAX 206/543-3835, E-mail slgray{at}u.washington.edu

OBJECTIVE: To describe the prevalence of potentially inappropriate medication use in community residential care (CRC) facilities at baseline, describe exposure to potentially inappropriate drugs during the 1-year follow-up, and examine characteristics associated with potentially inappropriate use.

DESIGN: A cohort study was conducted using 282 individuals aged 65 years entering a CRC facility in a 3-county area in the Puget Sound region of Washington State between April 1998 and December 1998 on Medicaid funding.

MAIN OUTCOME MEASURE: Use of potentially inappropriate medications as defined by explicit criteria (e.g., drugs that should generally be avoided in the elderly because potential risks outweigh any potential benefits).

RESULTS: Sixty-two (22%) residents took a total of 75 potentially inappropriate medications at baseline. The most common agents used at baseline were oxybutynin (3.5%) and amitriptyline (3.5%). The incidence of new use of potentially inappropriate medications was 0.1/100 person-days during the follow-up period. Potentially inappropriate use was related to self-reported fair or poor health (adjusted OR 1.42; 95% CI 1.05 to 1.92) and number of prescription drugs (adjusted OR 1.12; 95% CI 1.05 to 1.19). In the Cox proportional hazard model, no characteristics predicted new potentially inappropriate medication use during the follow-up.

CONCLUSIONS: Potentially inappropriate medication use is common among residents in CRC facilities. A comprehensive periodic review may be beneficial for reducing potentially inappropriate use, especially for patients taking multiple drugs.

Key Words: community residential care, drug utilization, elderly

Published Online, June 16, 2003. www.theannals.com, DOI 10.1345/aph.1C365

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