Prescribing indicators for evaluating drug use in nursing homes (original) (raw)

A ppropriateness of prescribing has gained much attention in studies about the quality of health care. 1-5 This is particularly true for elderly and nursing home patients. In view of the high rate of drug use, age-related pharmacokinetic and pharmacodynamic changes, and multiple comorbidities, elderly patients are at a higher risk of adverse drug effects (ADEs). 1,2,6,7 Schmader et al. 2 defined appropriate prescribing as the selection of a medication and instructions for its use that agree with accepted medical standards. These standards are based on efficacy, ADEs, and cost-effectiveness, and are derived from national and international guidelines, clinical trials, and expert opinion. Today, the concept of evidence-based medicine is included in daily medical practice. Evidence-based medicine is not only based on external clinical evidence, but also on individual clinical expertise. 8 To assess medication appropriateness, indicators that reflect deviations from national pharmacotherapy guidelines and drug formularies should be used. 9 The development of pharmacotherapy guidelines specifically for the elderly is generally limited. In the Netherlands, initiatives for Dutch nursing home patients are currently being developed. Several tools have been developed to assess the appropriateness of prescribing in the elderly. 1,5 Many of these were designed for assessing medication appropriateness in elderly outpatients rather than nursing home residents. Internationally, several studies have been published on prescribing indicators for elderly outpatients and nursing home residents. 11-15 In the Netherlands, however, studies on prescribing indicators are currently lacking. Prescribing indicators used in one healthcare system are not automatically OBJECTIVE: To evaluate drug use in 2 Dutch nursing homes (254 residents) by developing and evaluating prescribing indicators based on pharmacy prescription data.