Abstract
Background/objectives
Our aim was to describe the prevalence of potentially inappropriate medications (PIMs)
and potential prescribing omissions (PPOs) in Belgian nursing homes and to identify
characteristics of residents, general practitioners (GPs), and nursing homes (NHs)
that are associated with the number of PIMs and PPOs.
Design
A cross-sectional study.
Setting
and Participants: Nursing home residents (NHRs), aged ≥65 years, not in palliative
care were included in 54 Belgian NHs participating in the COME-ON study.
Measures
Instances of PIMs were detected using a combination of the STOPP v2 and AGS 2015 Beers
criteria. Instances of PPOs were detected using START v2. To assess factors associated
with the number of PIMs and PPOs, a multivariate binomial negative regression analysis
was performed.
Results
A total of 1410 residents, with a median age of 87 years, was included. The median
number of medications taken was 9. PIMs were detected in 88.3% of NHRs and PPOs in
85.0%. Use of benzodiazepines (46.7%) and omission of vitamin D (51.5%) were the most
common PIM and PPO, respectively. The factor most strongly associated with increased
PIMs was the use of 5 to 9 drugs or ≥10 drugs [relative risk (RR) (95% confidence
interval [CI]: 2.27 (1.89, 2.76) and 4.04 (3.37, 4.89), respectively]. The resident's
age was associated with both decreased PIMs and increased PPOs. PIMs and PPOs were
also associated with some NH characteristics, but not with GP characteristics.
Conclusion
Implications: The high prevalence of PIMs and PPOs remains a major challenge for the
NH setting. Future interventions should target in priority residents taking at least
10 medications and/or those taking psychotropic drugs. Future studies should explore
factors related to organizational and prescribing culture. Moreover, special attention
must be paid to the criteria used to measure inappropriate prescribing, including
criteria relative to underuse.
Keywords
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Article info
Publication history
Published online: July 25, 2018
Footnotes
This study is funded by the National Institute for Health and Disability Insurance (NIHDI) (Belgium). The funding body had a limited role in the design, but had no role in data collection, implementation, analysis, or the decision to publish the results. PA and GS were paid by the NIHDI.
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
