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Increase in drug use after admission to Dutch nursing homes
Raymond T C M Koopmans1, Jean-Pierre van der Borgh, J Hans J Bor
1Department of Nursing Home Medicine, University Medical Centre, Nijmegen, The Netherlands. R.Koopmans@vphg.umcn.nl
Objective:
To study changes in drug use after admission to Dutch nursing homes.
Setting:
Six nursing homes near the city of Nijmegen, The Netherlands.
Design:
Prospective longitudinal study.
Methods:
All patients who had been newly admitted to the nursing home were included in the study. Age, gender, residence of the patients before admission, and indication were registered. All prescriptions were registered with start-date and end-date. The nomenclature and subcategory definitions used were those of the World Health Organisation Nordic Anatomical Therapeutic Chemical classification index (ATC) codes. Patients had a follow-up of six weeks.
Results:
There was a minor, but statistically significant, increase in the mean number of drugs from 5.6 on admission to 5.8 six weeks later. Patients referred from a hospital and patients with a somatic indication were prescribed the highest number of drugs. On admission 5.5% of the patients were not on medication at all, 48% were using 1-2 drugs, and 46% had been prescribed 6 or more drugs. Six weeks after admission, a significant increase in drug use was found in drugs for the nervous system, and drugs for the sensory organs.
Conclusion:
Increase in drug use does not necessarily have to reflect bad prescribing practices. However, in this frail population, continuous drug review is needed to guarantee quality of prescribing and reduce unnecessary polypharmacy.