Prescribing indicators for evaluating drug use in nursing homes.
OBJECTIVE
To evaluate drug use in 2 Dutch nursing homes (254 residents) by developing and evaluating prescribing indicators based on pharmacy prescription data.


METHODS
We evaluated the prescribing of benzodiazepines, nonsteroidal antiinflammatory drugs (NSAIDs), ulcer-healing drugs, and diuretics. Prescribing indicators were used to identify prescribing that was potentially not in line with recommendations in national and regional prescribing guidelines. We used both descriptive indicators, such as the number and percentage of users, and indicators reflecting potentially suboptimal prescribing, such as use of drugs outside the regional drug formulary, use of >1 drug from the same drug class, and prescription of drug dosages above recommended values. When potentially suboptimal prescribing was found, we verified the findings by means of an interview with 1 of the prescribers.


RESULTS
The prescribing indicators we assessed were generally in agreement with national and regional guidelines. However, prescribing of NSAIDs without concomitant prescribing of gastroprotective drugs was found in a relatively high number of patients. After prescriber interview and patient chart review, it was found that some prescribing indicators, such as dosages above recommended values, were not always indicative for suboptimal prescribing.


CONCLUSIONS
This pilot study showed that prescribing indicators based solely on pharmacy prescription data can be a useful tool to evaluate drug prescribing. With some of these prescribing indicators, we identified cases of potentially suboptimal prescribing. However, with other indicators such as those based on drug dosages, we could not identify suboptimal prescribing, and clinical information from the prescriber was necessary to get insight into the appropriateness of prescribing.
van Dijk
Karen N
KN
Department of Clinical Pharmacy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. Karen.van.Dijk@znb.nl
Pont
Lisa G
LG
de Vries
Corinne S
CS
Franken
Maria
M
Brouwers
Jacobus R B J
JR
de Jong-van den Berg
Lolkje T W
LT
D000368:Aged; D011307:Drug Prescriptions / Q000592:standards*; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005569:Formularies as Topic; D017408:Guidelines as Topic; D006801:Humans; D009426:Netherlands; D009735:Nursing Homes / Q000592:standards*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010865:Pilot Projects; D015203:Reproducibility of Results
D004364:Pharmaceutical Preparations