Improving prescribing practices in nursing homes
Online posting: April 12, 1996
Published in print: June 1, 1996 (CMAJ 1996;154:1620)
Re: Strategies for improving prescribing practice, by Geoffrey M.
Anderson and Joel Lexchin, CMAJ 1996; 154: 1013–1017 [full text]
See also: Improving subscribing through use of CPS [letter]
This article makes an excellent contribution to solving an
important problem. Drug costs are the fastest rising portion of
health care expenditures. We also know that drugs are often used
inappropriately in nursing homes and that the number of people
needing nursing-home care will rise as our population ages. These
trends have prompted the US government to take drastic action to
reduce the use of antipsychotic drugs in nursing homes.[1] Since
Anderson and Lexchin state that one limitation of studies of the
minimization of drug use is a lack of clinical outcomes, I wish
to draw their attention to the effects of the cessation of
antipsychotic drug use in nursing homes.
In a follow-up to a study of educational measures to reduce the
prescribing of antipsychotic drugs in a nursing home, Ray and
associates[2] and Thapa and colleagues[3] performed detailed
patient assessments. They found that drug withdrawal was safe,
resulting in no increase in behavioural or functional problems
and a decrease in psychiatric symptoms.
Unfortunately, many elderly Canadians living in nursing homes
suffer as a result of inappropriate prescribing. A combined
approach involving prescriber education, improvement in nursing-
home resources and courageous government action could go a long
way to counteract this. The current series of articles in CMAJ is
a step in the right direction.
Chris MacKnight, MD
Author name
Division of Geriatric Medicine
Dalhousie University
Halifax, NS
cmacknig@is.dal.ca
References
- Elon R, Pawlson LG: The impact of OBRA on medical practice within nursing facilities. J Am Geriatr Soc 1992; 40: 958–963
- Ray WA, Taylor JA, Meador KG et al: Reducing antipsychotic use in nursing homes: a controlled trial of provider education. Arch Intern Med 1993; 153: 713–721
- Thapa PB, Meador KG, Gideon P et al: Effects of
antipsychotic withdrawal in elderly nursing home residents.
J Am Geriatr Soc 1994; 42: 280–286
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