Extent of medication use in U.S. long-term-care facilities

A review of the literature on the extent of medication ordering and consumption in long-term-care facilities is presented. Studies conducted in the United States were evaluated to answer two questions: (1) What is known about how much medication, particularly p.r.n. medication, is ordered for and consumed by residents of long-term-care facilities? and (2) What factors are related to medication use in these facilities? The studies most commonly determined how much medication was being ordered or prescribed in long-term-care facilities by assessing the number of medications (or prescriptions) per resident at a given point in time or on a particular day. Most studies report that about seven medications were ordered per resident at any one point in time. However, because of the variation in indices and time frames, generalizing about the extent of actual medication consumption is not possible. Residents' characteristics, pharmacy and drug policy characteristics, and facility characteristics were studied to determine whether they are related to the ordering or use of medications in long-term-care facilities. It is notable that the effect of residents' illness was rarely examined or controlled for. The different variables under examination among the various studies make many current findings tentative. Future researchers need to apply conceptual models that allow a coherent summary of the findings.