Analgesic and adjuvant co-prescribing in Australian and Finnish residential care homes

To explore the co-prescribing of analgesic and/or adjuvant medications among residents of Australian and Finnish residential care homes.

Secondary cross-sectional analyses of prescribing data from residents of 12 Australian residential care homes in 2019 and 53 Finnish nursing homes and assisted living facilities in 2017-2018. Demographic characteristics and medication data were extracted from medical records and medication administration charts. Co-prescribing was defined as more than one analgesic (acetaminophen, non-steroidal anti-inflammatory drugs and opioids) and/or adjuvant (gabapentinoids, tricyclic antidepressants and duloxetine) medication prescribed for regular administration.

Overall, 550 Australian residents (89 [IQR 84-92] years; 73% females) and 2423 Finnish residents (84 [IQR 65-103] years; 74% females) were included. Of 416 Australian residents prescribed any regular analgesic or adjuvant, 181 (44%) were prescribed two or more, including 66 (16%) who were prescribed three or more. Of 1406 Finnish residents prescribed any regular analgesic or adjuvant, 469 (33%) were prescribed two or more, including 87 (6%) who were prescribed three or more. Acetaminophen was co-prescribed to more than 75% of Australian and 43% of Finnish residents prescribed other analgesics or adjuvants. Of 61 Australian residents and 186 Finnish residents prescribed gabapentinoids, 38 (62%) and 86 (46%) were co-prescribed opioids. Opioids were co-prescribed to 59%-83% of Australian and 25%-46% of Finnish residents prescribed adjuvants.

Analgesic and adjuvant co-prescribing was more prevalent for Australian than Finnish residents, which was largely driven by acetaminophen co-prescribing to more than three quarters of analgesic or adjuvant users in Australia. Central nervous system-active polypharmacy arising from high rates of adjuvant and opioid co-prescribing warrants further attention.