Inappropriate drug prescribing and related outcomes for elderly medicaid beneficiaries residing in nursing homes

Problems of drug prescribing are related to poor economic and clinical outcomes, and there is a common perspective that prescribing in nursing homes is suboptimal. This study purported to determine how prescribing of "inappropriate" drugs, health care provider-related factors, and patient demographics were related to the cost of pharmaceutical services and the mortality of elderly Medicaid beneficiaries in Louisiana's Intermediate Care Facilities I during 1994. Inappropriate drugs for this retrospective, observational, and cross-sectional study were identified using explicit criteria. Relevant data on the population of 19,932 beneficiaries were extracted from the state Medicaid files and analyzed using multiple linear and binomial logit regression procedures. Cost of pharmaceutical services for a beneficiary was positively correlated with the number of different inappropriate drugs prescribed, number of physicians and pharmacies used, and the geographic region. It was negatively correlated with the beneficiary's age. Probability of the beneficiary's mortality was positively correlated with the number of pharmacies used and negatively correlated with one geographic region. Minimizing the number of different inappropriate drugs prescribed, as well as the numbers of prescribers and pharmacies used, for an elderly beneficiary may reduce the cost of pharmaceutical services paid by Medicaid.