title: Pattern of prescriptions issued by nursing home-based physicians versus office-based physicians for frail elderly patients in German nursing homes.
abstract: OBJECTIVE
  The purpose of this study was to describe the physician prescription pattern for frail elderly patients in German nursing homes and to identify differences, if any, between that of physicians based in the nursing homes (A) and those with office-based practices (B).
  
  
  METHODS
  Retrospective, longitudinal study of medication prescriptions on the basis of the database of a health insurance (Betriebskrankenkasse) in Berlin, Germany. We assessed the medication prescriptions for all 996 unselected insured individuals aged > or = 60 years who were insured throughout 1999 and lived in nursing homes. We analyzed selected patient characteristics and prescription data. Drugs were classified according to the WHO ATC code and were assigned a mean daily defined dose (DDD).
  
  
  RESULTS
  816 individuals were women and 180 were men. A total of 78% of women and 43% of men were aged 80 years or older. Two hundred sixty three patients were seen by nursing home-based physicians (A) and 733 by office-based physicians (B). The median of prescriptions per patient and year was 31 (A) and 37 (B) (p between groups < 0.001). Patients in Group A also received a lower number of DDDs in comparison to Group B (1109 vs 1250; p < 0.01). Costs were substantially higher in group B, and in both groups higher in the 60-69 years old in comparison to the more senior patients. The prescription pattern suggested a considerable frequency of inappropriate drug use in both groups in the following classes: psychopharmacological agents (neuroleptics, antidepressants, hypnotics), pain medication, digitalis glycosides, laxants and loop diuretics. On an average, office-based physicians (B) prescribed relatively more medications in all major classes with the exception of non-opiate analgesics, laxants and anxiolytics.
  
  
  CONCLUSIONS
  These data are indicative of a considerable use of inappropriate medication for frail geriatric patients. Differences between the prescribing pattern among nursing home-based and office-based physicians were not substantial, however, the latter group prescribed relatively more drugs.
authors.affiliation: Institute of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Fiedlerstr 27, D-01307 Dresden, Germany. david.pittrow@mailbox.tu-dresden.de
authors.forename: David
authors.initials: D
authors.lastname: Pittrow
authors.forename: J
authors.initials: J
authors.lastname: Krappweis
authors.forename: A
authors.initials: A
authors.lastname: Rentsch
authors.forename: C
authors.initials: C
authors.lastname: Schindler
authors.forename: I
authors.initials: I
authors.lastname: Hach
authors.forename: P
authors.initials: P
authors.lastname: Bramlage
authors.forename: W
authors.initials: W
authors.lastname: Kirch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006299:Health Services for the Aged; D006707:Homes for the Aged; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009819:Office Visits; D017891:Pharmacoepidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies