title: Potentially inappropriate drug prescribing and associated factors in nursing homes.
abstract: OBJECTIVE
  Polymedication is frequent in nursing home (NH) residents. This increases the risk of potentially inappropriate drug prescribing (PIDP), which can lead to adverse drug events, such as falls and hospitalization.
  
  
  OBJECTIVE
  To identify PIDP in NH residents and to investigate subject-related and NH structural and organizational factors associated with PIDP.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A total of 175 NHs in Midi-Pyrénées region, South-Western France.
  
  
  METHODS
  A total of 974 subjects randomly selected from the 6275 NH residents participating in the IQUARE study.
  
  
  METHODS
  Patients with PIDP.
  
  
  METHODS
  PIDP was the main outcome measure. It was defined using a specific indicator, based on the Summary of Product Characteristics, on the Laroche list, and on residents' clinical data. PIDP was defined as the presence of at least 1 of the following criteria: (1) drug with an unfavorable benefit-to-risk ratio; (2) drug with questionable efficacy according to the Laroche list; (3) absolute contraindication; (4) significant drug-drug interaction. Associated factors were identified by using multivariable logistic regression models.
  
  
  RESULTS
  Among the 974 residents included, 71% had PIDP. PIDP was more frequent in patients without dementia, with several comorbidities and taking multiple medications. In the multivariable analysis, age (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.03) and Charlson Comorbidity Index (CCI; P = .003, CCI = 1 versus 0: OR1/0 1.22; 95% CI 0.85-1.74, CCI ≥ 2 versus 0: OR2/0 1.72; 95% CI 1.23-2.41) were associated with an increased likelihood of PIDP. By contrast, dementia was associated with a lower likelihood of PIDP (OR 0.70; 95% CI 0.53-0.94). Among NH structural and organizational characteristics, the access to psychiatric advice and/or to hospitalization in a psychiatric unit (OR 1.36; 95% CI 1.02-1.82) and the presence of a reevaluation of drug prescriptions (OR 1.45; 95% CI 1.07-1.96) were associated with an increased likelihood of PIDP.
  
  
  CONCLUSIONS
  Our work suggests that some NH characteristics are associated with an increased likelihood of PIDP. Gaining a better understanding of the factors influencing PIDP, especially structural and organizational NH factors, can help to determine the interventions that should be implemented.
authors.affiliation: UMR INSERM 1027, University of Toulouse III, Toulouse, France; Service de Pharmacologie Clinique, Centre Hospitalo-Universitaire de Toulouse (CHU de Toulouse), Toulouse, France; Pôle Pharmacie, CHU de Toulouse, Toulouse, France. Electronic address: cool.c@chu-toulouse.fr.
authors.forename: Charlène
authors.initials: C
authors.lastname: Cool
authors.affiliation: UMR INSERM 1027, University of Toulouse III, Toulouse, France; Pôle Pharmacie, CHU de Toulouse, Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cestac
authors.affiliation: Pôle Pharmacie, CHU de Toulouse, Toulouse, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Laborde
authors.affiliation: Pôle Pharmacie, CHU de Toulouse, Toulouse, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Lebaudy
authors.affiliation: UMR INSERM 1027, University of Toulouse III, Toulouse, France; Pôle Pharmacie, CHU de Toulouse, Toulouse, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Rouch
authors.affiliation: UMR INSERM 1027, University of Toulouse III, Toulouse, France; Service d'épidémiologie, CHU de Toulouse, Toulouse, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lepage
authors.affiliation: UMR INSERM 1027, University of Toulouse III, Toulouse, France; Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
authors.affiliation: Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; UMR 7268 ADES, Aix-Marseille Université/EFS/CNRS, Marseille, France.
authors.forename: Philipe de Souto
authors.initials: Pde S
authors.lastname: Barreto
authors.affiliation: UMR INSERM 1027, University of Toulouse III, Toulouse, France; Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Rolland
authors.affiliation: UMR INSERM 1027, University of Toulouse III, Toulouse, France; Service de Pharmacologie Clinique, Centre Hospitalo-Universitaire de Toulouse (CHU de Toulouse), Toulouse, France.
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D057970:Inappropriate Prescribing; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D019338:Polypharmacy
keywords: Nursing homes; drug prescribing; elderly; inappropriate prescribing; pharmacoepidemiology