Prescribing indicators for evaluating drug use in nursing homes

Area of Science:

• Geriatric Pharmacy
• Health Services Research
• Pharmacovigilance

Background:

• Evaluating medication use in nursing home residents is crucial for patient safety.
• Pharmacy prescription data offers a potential source for monitoring drug prescribing patterns.
• Developing effective prescribing indicators is key to identifying potential medication-related problems.

Purpose of the Study:

• To develop and assess the utility of prescribing indicators using pharmacy data to evaluate drug use in Dutch nursing homes.
• To identify potentially suboptimal prescribing of specific drug classes, including benzodiazepines, NSAIDs, ulcer-healing drugs, and diuretics.

Main Methods:

• Prescribing indicators were developed based on national and regional guidelines.
• Indicators assessed included drug class usage, formulary adherence, polypharmacy, and dosage levels.
• Potentially suboptimal prescribing identified by indicators was verified through prescriber interviews and chart reviews.

Main Results:

• Prescribing indicators generally aligned with guidelines.
• A high rate of nonsteroidal anti-inflammatory drug (NSAID) prescribing without gastroprotection was observed.
• Dosage-based indicators were not always reliable for identifying suboptimal prescribing without additional clinical context.

Conclusions:

• Pharmacy prescription data, when used with carefully developed indicators, can be a valuable tool for evaluating drug prescribing in nursing homes.
• Some indicators effectively identified potentially suboptimal prescribing, while others required clinical validation.
• Further refinement and integration of clinical data are necessary for comprehensive assessment of prescribing appropriateness.