Suboptimal pharmacotherapy in a tribal nursing home.
OBJECTIVE
Suboptimal medication use among nursing home (NH) residents is common. NH residents tend to be older, suffer from multiple conditions, and take numerous medications, increasing their risk of serious complications. This article examines pharmacotherapy in a rural, tribally owned NH.


METHODS
Medical records were reviewed and case studies were conducted by a team composed of a medical anthropologist, psychiatrist, and geriatrician.


METHODS
A rural, American Indian-owned NH in the US northern plains.


METHODS
40 American Indian and 5 EuroAmerican NH residents.


METHODS
Minimum Data Set assessments, admission records, care plans, social histories, prescription lists, and behavioral consultation reports.


RESULTS
Potential underuse affected almost 75% of residents; undertreatment of depressive and psychotic/agitated symptoms was especially common. Potential inappropriate use, especially of analgesics, psychotropics, and antihistamines, affected 30% of residents. A smaller, but still substantial, number of residents (21%) experienced potential overuse, much of which involved anticonvulsants, antibiotics, cardiovascular, and psychotropic agents. The prescription of 10 or more medications was significantly associated with potential drug interactions, as well as underuse, inappropriate medication use, and overuse.


CONCLUSIONS
Psychotropic medications were the most potentially problematic medication category, and were strongly implicated in potential underuse, inappropriate use, and overuse. Fewer medications; the discontinuation of drugs known to be potentially problematic for NH residents; modification of psychotropic medication regimens; use of cognitive-enhancing medications where appropriate; implementation of an electronic medical record system; and greater use of nonpharmacological behavioral interventions may have substantially improved residents' treatment regimens.
Jervis
Lori L
LL
American Indian and Alaska Native Programs, Department of Psychiatry, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045, USA. lori.jervis@uchsc.edu
Shore
Jay
J
Hutt
Evelyn
E
Manson
Spero M
SM
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D004347:Drug Interactions; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D005260:Female; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D007198:Indians, North American; D008297:Male; D008485:Medical Audit; D008487:Medical History Taking; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D014481:United States