Impact of a geriatric nursing home palliative care service on unnecessary medication prescribing.
BACKGROUND
There is a lack of studies concerning improvement of medication use in palliative care patients in nursing homes.


OBJECTIVE
This study was conducted to evaluate whether a geriatric palliative care team reduced unnecessary medication prescribing for elderly veterans residing in a nursing home.


METHODS
This was a retrospective, descriptive study of patients who died while residing in a geriatric palliative care unit between August 1, 2005, and July 31, 2007. Prescribed medications were evaluated using the Unnecessary Drug Use Measure, which contains 3 items from the Medication Appropriateness Index concerning lack of indication, lack of effectiveness, and therapeutic duplication. This measure was applied at 2 time points: on transfer/admission to the palliative care unit and at the last 30-day pharmacist medication review before death. Paired t tests and McNemar tests were used to compare medication use at these 2 points.


RESULTS
Eighty-nine patients were included in the study. The majority were male (97.8%) and white (78.7%), with a mean (SD) age of 79.7 (7.8) years. The median length of stay on the unit was 39.0 days, and the mean number of chronic medical conditions was 8.4 (4.3). At baseline, the mean number of scheduled medications was 9.7 (4.3). The number of unnecessary medications per patient decreased from a mean of 1.7 (1.5) at admission to 0.6 (0.8) at closeout (P = 0.003). The decrease was seen in all 3 categories of the Unnecessary Drug Use Measure.


CONCLUSIONS
The geriatric palliative care team was associated with a reduction in the number of unnecessary medications prescribed for older veterans in this nursing home. Future studies should evaluate the impact of decreasing unnecessary prescribing on clinical outcomes such as adverse drug reactions.
Suhrie
Erin M
EM
Pharmacy Department, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Hanlon
Joseph T
JT
Jaffe
Emily J
EJ
Sevick
Mary Ann
MA
Ruby
Christine M
CM
Aspinall
Sherrie L
SL
D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data; D004358:Drug Therapy / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000379:methods*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration; D010146:Pain / Q000188:drug therapy*; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D019338:Polypharmacy; D012189:Retrospective Studies; D014481:United States; D014728:Veterans