Reducing the use of H2-receptor antagonists in the long-term-care setting.
OBJECTIVE
To examine the patterns of H2 blocker use in the long-term-care setting and to assess the effect of educational interventions designed to improve H2 blocker utilization patterns.


METHODS
Time-series quasi-experimental study and retrospective chart review.


METHODS
A large academically-oriented long-term-care facility.


METHODS
Institutionalized elderly patients with a mean age of 88 years receiving H2 blocker therapy.


METHODS
Two interventions involving group discussions with the medical staff, supporting educational materials, and physician-specific listings of patients receiving H2 blockers were employed sequentially over a 32-month period.


RESULTS
Each intervention resulted in substantial reductions in medication use (59.6% and 32.1%, respectively). Indications for H2 blocker use were determined retrospectively for patients identified as receiving therapy prior to the interventions (n = 110). Forty-one percent were found to be receiving therapy for reasons unsubstantiated by the medical literature. These patients were more likely to be discontinued from therapy than those receiving therapy for substantiated indications (P less than 0.01), consistent with the primary focus of the educational interventions.


CONCLUSIONS
These results suggest that the excessive use of H2 blocker therapy in the long-term care setting responds to educational interventions with therapeutically appropriate reductions in utilization. Repeated interventions are necessary to maintain such reductions over time although there may be some reduction in the effectiveness of the intervention with repetition.
Hebrew Rehabilitation Center for Aged, Boston, MA.
J H
JH
Gurwitz
J P
JP
Noonan
S B
SB
Soumerai
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D004502:Education, Medical, Continuing / Q000191:economics / Q000379:methods / Q000592:standards*; D005260:Female; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008503:Medical Staff / Q000193:education*; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies
D006635:Histamine H2 Antagonists