title: Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs.
abstract: OBJECTIVE
  To examine and compare the quality of drug prescribing for older patients in nursing homes and home nursing services.
  
  
  METHODS
  Cross-sectional study comprising 11,254 patients aged ≥ 65 years in nursing homes (n = 2986) and home nursing services (n = 8268). Potentially inappropriate medications were identified by using the Norwegian General Practice criteria and drug-drug interactions through a Norwegian Web-based tool. The impact of care setting on exposure to selected drug groups, potentially inappropriate medications, and drug interactions was calculated, adjusting for patients' age, gender, and number of drugs used.
  
  
  RESULTS
  Patients in nursing homes and home nursing services used on average 5.7 (SD = 2.6) multidose dispensed regular drugs. Twenty-six percent used at least one potentially inappropriate medication, 31% in nursing homes and 25% in home nursing services, p < .001. Concomitant use of three or more psychotropic and/or opioid drugs was the criterion most commonly identified in nursing homes (18%) and home nursing services (9%), p < .001. Compared with nursing homes, more patients in home nursing services used cardiovascular drugs and fewer patients used psychotropic drugs. Altogether, 8615 drug-drug interactions were identified in 55% of patients, 48% in nursing homes and 57% in home nursing services, p < .001.
  
  
  CONCLUSIONS
  There are significant differences in the quality of drug prescribing in nursing homes compared with home nursing services. Explanations as to why these differences exist need to be further explored.
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. kjell.halvorsen@isf.uib.no
authors.forename: Kjell H
authors.initials: KH
authors.lastname: Halvorsen
authors.forename: Anne Gerd
authors.initials: AG
authors.lastname: Granas
authors.forename: Anders
authors.initials: A
authors.lastname: Engeland
authors.forename: Sabine
authors.initials: S
authors.lastname: Ruths
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004347:Drug Interactions; D005260:Female; D006699:Home Care Services / Q000592:standards / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D020407:Internet; D008297:Male; D009664:Norway; D009735:Nursing Homes / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data*; D011787:Quality of Health Care