Evaluation of prescribing quality in nursing homes based on drug-specific indicators: The Bergen district nursing home (BEDNURS) study

Objectives: To examine prescribing quality among nursing home patients. Methods: A cross sectional study in 23 nursing homes, based on drug charts. The evaluation of prescribing quality was based on selected drug-specific indicators established by the Swedish National Board of Health and Welfare. Logistic regression analysis was used to examine associations between prescribing indicators and predictors related to patient (age, gender, drug number) and institution (nurse and physician staff time) characteristics. Results: A total of 1513 nursing home patients (76% women, mean age 85 years) were included in the study. On average, the patients used 5.1 (SD 2.5) standing medications. Laxatives were most commonly used (58%), followed by loop-diuretics (35%), antidepressants (31%), and anti-thrombotic agents (27%). Altogether 850 (56%) patients used at least one potentially inappropriate prescription (PIP), including long-term use of contact laxatives without proper indication (25%), long-acting benzodiazepines (17%), and anticholinergic drugs (16%). The number of drugs used was the most important determinant for any PIP as well as for all individual indicators (p<0.001). Relatively younger patients were more likely to receive any PIP, and in particular anticholinergic drugs, multiple psychotropic drugs, and interacting drugs (p<0.05). Conclusion: Prescribing quality assessment by use of drug-specific indicators revealed great potentials for improving drug therapy in Norwegian nursing homes.