Marie Herr1,2,3, Helene Grondin4,5, Stéphane Sanchez6,7, Didier Armaingaud8, Caroline Blochet9, Antoine Vial10, Philippe Denormandie7, Joël Ankri4,5,11. 1. INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France. marie.herr@uvsq.fr. 2. Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, 2, avenue de la source de la Bièvre, F-78180, Montigny le Bretonneux, France. marie.herr@uvsq.fr. 3. Département Hospitalier d'Epidémiologie et de Santé Publique, Hôpital Sainte Périne, APHP, Paris, France. marie.herr@uvsq.fr. 4. INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France. 5. Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, 2, avenue de la source de la Bièvre, F-78180, Montigny le Bretonneux, France. 6. Pôle Information Médicale Evaluation Performance, Centre Hospitalier de Troyes, Troyes, France. 7. Institut du Bien Vieillir, Paris, France. 8. Korian, Paris, France. 9. Medissimo, Poissy, France. 10. AVL, Paris, France. 11. Département Hospitalier d'Epidémiologie et de Santé Publique, Hôpital Sainte Périne, APHP, Paris, France.
Abstract
PURPOSE: The quality of drug therapy is an important issue for nursing homes. This study aimed to assess the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a large sample of nursing home residents by using the data recorded during the preparation of pill dispensers. METHODS: This is a cross-sectional study that included 451 nursing homes across France. Information about the medications received by the 30,702 residents (73.8% women) living in these nursing homes was extracted from the system that assists in the preparation of pill dispensers in pharmacies. The anonymized database included age, sex, and medications prescribed to residents, as well as nursing home characteristics (capacity, legal status). Factors associated with excessive polypharmacy (≥10 different drugs) and PIMs according to the Laroche list were studied using multilevel regression models. RESULTS: The average number of drugs prescribed was 6.9 ± 3.3, and excessive polypharmacy concerned 21.1% of the residents (n = 6468). According to the Laroche list, 47.4% of residents (n = 14,547) received at least one PIM. Benzodiazepines (excessive doses, long-acting benzodiazepines, and combination of benzodiazepines) and anticholinergic medications (hydroxyzine, cyamemazine, alimemazine) accounted for a large part of PIMs. Individual characteristics (age, gender) influenced the risk of receiving PIMs whereas nursing home characteristics (capacity, legal status) influenced the risk of excessive polypharmacy. CONCLUSIONS: This study shows that polypharmacy and PIMs remain highly prevalent among nursing home residents. Main PIMs concerned psychotropic and anticholinergic medications.
PURPOSE: The quality of drug therapy is an important issue for nursing homes. This study aimed to assess the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a large sample of nursing home residents by using the data recorded during the preparation of pill dispensers. METHODS: This is a cross-sectional study that included 451 nursing homes across France. Information about the medications received by the 30,702 residents (73.8% women) living in these nursing homes was extracted from the system that assists in the preparation of pill dispensers in pharmacies. The anonymized database included age, sex, and medications prescribed to residents, as well as nursing home characteristics (capacity, legal status). Factors associated with excessive polypharmacy (≥10 different drugs) and PIMs according to the Laroche list were studied using multilevel regression models. RESULTS: The average number of drugs prescribed was 6.9 ± 3.3, and excessive polypharmacy concerned 21.1% of the residents (n = 6468). According to the Laroche list, 47.4% of residents (n = 14,547) received at least one PIM. Benzodiazepines (excessive doses, long-acting benzodiazepines, and combination of benzodiazepines) and anticholinergic medications (hydroxyzine, cyamemazine, alimemazine) accounted for a large part of PIMs. Individual characteristics (age, gender) influenced the risk of receiving PIMs whereas nursing home characteristics (capacity, legal status) influenced the risk of excessive polypharmacy. CONCLUSIONS: This study shows that polypharmacy and PIMs remain highly prevalent among nursing home residents. Main PIMs concerned psychotropic and anticholinergic medications.
Authors: Anne R Grace; Robert Briggs; Ruth E Kieran; Roisin M Corcoran; Roman Romero-Ortuno; Tara L Coughlan; Desmond O'Neill; Rónán Collins; Sean P Kennelly Journal: J Am Med Dir Assoc Date: 2014-10-07 Impact factor: 4.669
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