[Improving adequacy for drug use and effects in geriatric centers using an intervention program]

Abstract

Objective: To evaluate the impact of a program for increasing adequacy of drug prescriptions in a group of nursing homes 2 years after implementation.

Method: This quasi-experimental before and after study was carried out with a control group in various centers. It included all outpatient prescriptions, individualized by centre, during the study period (reference: year 2001 and post-intervention: year 2003) with 107/118 nursing homes from the Región Sanitaria del Barcelonés Norte y Maresme (Barcelona) included in each period. After an initial situation analysis, centers were assigned to two different groups: intervention group (n = 32) and control group (n = 75/86). Number of residents: 4,798/5,816 (years: 2001/2003). Actions accomplished in the intervention group were: a) presentation letter, b) informative interview c) management control and d) monitorization with follow-up interviews. Quantitative (total cost of drugs among residents) and qualitative indicators (high intrinsic pharmacologic value drug use, generic drug use and super-night diaper use) were established as measurement units, together with relative use values.

Results: In the intervention group, cost contention was evident. Cost per resident was 1,671.89 EUR +/- 458.33 EUR in the reference period and 1,821.22 EUR +/- 311.88 EUR during the post-intervention period (inter-annual increment of 8.9% vs. 19.5% compared to the control group; p = 0.002). Number of packages per resident showed an inter-annual increment of 2.5% and 11.4% (p = 0.001) respectively. An increased use of generic drugs (7.9% and 18.4%), antiasthmatic agents, omeprazol and recommended nonsteroidal antiinflammatory agents was observed; while there were no differences in the use of antidepressants and antibiotics.

Conclusions: The preliminary results have shown improved efficiency of pharmaceutical prescriptions in nursing homes included in the intervention group. The methodology used appears to be appropriate for promoting rational use of drugs and improving prescription quality.