Quality of prescribing in care homes and the community in England and Wales

Sunil M Shah, Iain M Carey, Tess Harris, Stephen DeWilde, Derek G Cook
British Journal of General Practice 2012, 62 (598): e329-36

BACKGROUND: Care home residents are vulnerable to the adverse effects of prescribing but there is limited monitoring in the UK.

AIM: To compare prescribing quality in care homes in England and Wales with the community and with US nursing homes.

DESIGN AND SETTING: Cross-sectional analysis of a UK primary care database and comparison with the US National Nursing Home Survey including 326 general practices in 2008-2009 in England and Wales, with 10 387 care home and 403 259 community residents aged 65 to 104 years.

METHOD: Comparison of age- and sex-standardised use of 'concern' and common drug groups in the last 90 days and potentially inappropriate prescribing based on a consensus list of medications best avoided in older people (Beers criteria).

RESULTS: Compared to the community, care home residents were more likely to receive 'concern' drugs, including benzodiazepines (relative risk (RR) = 2.05, 95% confidence interval (CI) = 1.90 to 2.22), anticholinergic antihistamines (RR = 2.78, 95% CI = 2.38 to 3.23), loop diuretics (RR = 1.47, 95% CI = 1.41 to 1.53), and antipsychotics (RR = 22.7, 95% CI = 20.6 to 24.9). Use of several common drug groups, including laxatives, antidepressants, and antibiotics, was higher, but use of cardiovascular medication was lower. Thirty-three per cent (95% CI = 31.7% to 34.3%) of care home residents in England and Wales received potentially inappropriate medication, compared to 21.4% (95% CI = 20.9% to 21.8%) in the community. The potentially inappropriate prescribing rate in US nursing homes was similar to England and Wales.

CONCLUSION: Care home prescribing has the potential for improvement. High use of anticholinergic and psychotropic medication may contribute to functional and cognitive decline. The targeting and effectiveness of medication reviews in care homes needs to be improved.

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