Improving medication prescribing and utilization in the nursing home.

Area of Science:

• Gerontology
• Pharmacology
• Health Services Research

Background:

• Inappropriate medication use is prevalent in nursing homes, causing adverse drug reactions and economic burdens.
• Quality of care concerns and regulatory changes necessitate improved drug use monitoring in these facilities.
• Current interventions often rely on consultant pharmacists, but evidence of their impact is limited.

Purpose of the Study:

• To review existing approaches for monitoring and improving drug utilization in nursing homes.
• To evaluate the effectiveness of different interventions aimed at reducing inappropriate prescribing.
• To highlight the need for better study designs and outcome measures in future research.

Main Methods:

• Review of studies investigating interventions to reduce inappropriate prescribing and drug utilization in nursing homes.
• Comparison of nursing home interventions with hospital-based approaches.
• Analysis of the role of nursing staff in medication management.

Main Results:

• Nursing home interventions have primarily focused on consultant-pharmacist activities, with limited evidence of effectiveness.
• Physician-targeted "academic detailing" has shown success in improving prescribing for certain medications.
• Educational interventions excluding nursing staff may be insufficient for medications heavily influenced by nurses.

Conclusions:

• There is a need for more rigorous studies to assess the impact and cost-effectiveness of drug use interventions in nursing homes.
• Future research should incorporate adequate study designs and focus on clinical outcomes.
• Involving nursing staff in educational interventions is crucial for positively influencing drug utilization.