title: Quality of prescribing in care homes and the community in England and Wales.
abstract: BACKGROUND
  Care home residents are vulnerable to the adverse effects of prescribing but there is limited monitoring in the UK.
  
  
  OBJECTIVE
  To compare prescribing quality in care homes in England and Wales with the community and with US nursing homes.
  
  
  METHODS
  Cross-sectional analysis of a UK primary care database and comparison with the US National Nursing Home Survey including 326 general practices in 2008-2009 in England and Wales, with 10 387 care home and 403 259 community residents aged 65 to 104 years.
  
  
  METHODS
  Comparison of age- and sex-standardised use of 'concern' and common drug groups in the last 90 days and potentially inappropriate prescribing based on a consensus list of medications best avoided in older people (Beers criteria).
  
  
  RESULTS
  Compared to the community, care home residents were more likely to receive 'concern' drugs, including benzodiazepines (relative risk (RR) = 2.05, 95% confidence interval (CI) = 1.90 to 2.22), anticholinergic antihistamines (RR = 2.78, 95% CI = 2.38 to 3.23), loop diuretics (RR = 1.47, 95% CI = 1.41 to 1.53), and antipsychotics (RR = 22.7, 95% CI = 20.6 to 24.9). Use of several common drug groups, including laxatives, antidepressants, and antibiotics, was higher, but use of cardiovascular medication was lower. Thirty-three per cent (95% CI = 31.7% to 34.3%) of care home residents in England and Wales received potentially inappropriate medication, compared to 21.4% (95% CI = 20.9% to 21.8%) in the community. The potentially inappropriate prescribing rate in US nursing homes was similar to England and Wales.
  
  
  CONCLUSIONS
  Care home prescribing has the potential for improvement. High use of anticholinergic and psychotropic medication may contribute to functional and cognitive decline. The targeting and effectiveness of medication reviews in care homes needs to be improved.
authors.affiliation: Division of Population Health Science and Education, St George's University of London, UK. sushah@sgul.ac.uk
authors.forename: Sunil M
authors.initials: SM
authors.lastname: Shah
authors.forename: Iain M
authors.initials: IM
authors.lastname: Carey
authors.forename: Tess
authors.initials: T
authors.lastname: Harris
authors.forename: Stephen
authors.initials: S
authors.lastname: DeWilde
authors.forename: Derek G
authors.initials: DG
authors.lastname: Cook
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000592:standards*; D003430:Cross-Sectional Studies; D004739:England; D005194:Family Practice / Q000592:standards*; D005260:Female; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D055553:Prescription Drugs / Q000627:therapeutic use*; D019564:Unnecessary Procedures; D014852:Wales
chemical_list: D055553:Prescription Drugs