Drug use in Swedish nursing homes

Abstract

Objective: To describe the overall drug use in Swedish nursing homes and to comment on the impact of regular multidisciplinary team interventions on the quantity of inappropriate medications.

Design and setting: This randomised, controlled trial was carried out in a sample of 33 nursing homes, 15 experimental homes and 18 control homes, representing 5% of all Swedish nursing homes.

Participants: The sample consisted of 1854 nursing home residents with an average age of 83 years. 70% of the residents were female and 42% had a documented diagnosis of dementia. An additional 5% had a psychotic disorder and 7% had a diagnosis of depression.

Measurements: Lists of each resident's prescriptions were collected 1 month before and 1 month after the 12-month intervention. Measures included the proportion of residents receiving any particular drug. The number of drugs classified by guidelines as inappropriate was also measured before and after the intervention period.

Results: The nursing home residents were prescribed on average 7.7 medications, the majority on a regular basis. The most frequently prescribed group of drugs was laxatives, followed by psychotropic agents and cardiovascular drugs. Some groups of drugs decreased in the intervention homes.

Conclusion: Extensive and somewhat inappropriate drug use in Swedish nursing homes is a significant and serious problem. Careful monitoring is necessary to ensure well tolerated drug therapy in this frail population. Neither written information from the Medical Products Agency, nor the campaign in the pharmacies alone had an impact on drug use in Swedish nursing homes. Multidisciplinary team discussions contributed to improved drug use, but more research is needed to understand the mechanisms behind this finding.