Appropriateness of use of medicines in elderly inpatients: qualitative study.
OBJECTIVE
To explore the processes leading to inappropriate use of medicines for elderly patients admitted for acute care.


METHODS
Qualitative study with semistructured interviews with doctors, nurses, and pharmacists; focus groups with inpatients; and observation on the ward by clinical pharmacists for one month.


METHODS
Five acute wards for care of the elderly in Belgium.


METHODS
5 doctors, 4 nurses, and 3 pharmacists from five acute wards for the interviews; all professionals and patients on two acute wards for the observation and 17 patients (from the same two wards) for the focus groups.


RESULTS
Several factors contributed to inappropriate prescribing, counselling, and transfer of information on medicines to primary care. Firstly, review of treatment was driven by acute considerations, the transfer of information on medicines from primary to secondary care was limited, and prescribing was often not tailored to elderly patients. Secondly, some doctors had a passive attitude towards learning: they thought it would take too long to find the information they needed about medicines and lacked self directed learning. Finally, a paternalistic doctor-patient relationship and difficulties in sharing decisions about treatment between prescribers led to inappropriate use of medicines. Several factors, such as the input of geriatricians and good communication between members of the multidisciplinary geriatric team, led to better use of medicines.


CONCLUSIONS
In this setting, improvements targeted at the abilities of individuals, better doctor-patient and doctor-doctor relationships, and systems for transferring information between care settings will increase the appropriate use of medicines in elderly people.
Spinewine
Anne
A
Centre for Clinical Pharmacy, School of Pharmacy, Université catholique de Louvain, 1200 Brussels, Belgium. anne.spinewine@facm.ucl.ac.be
Swine
Christian
C
Dhillon
Soraya
S
Franklin
Bryony Dean
BD
Tulkens
Paul M
PM
Wilmotte
Léon
L
Lorant
Vincent
V
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001530:Belgium; D003376:Counseling / Q000592:standards; D003657:Decision Making; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006299:Health Services for the Aged / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010817:Physician-Patient Relations
D004364:Pharmaceutical Preparations