A case study using the beers list criteria to compare prescribing by family practitioners and geriatric specialists in a rural nursing home

Abstract

Previous studies have concluded that inappropriate medications and/or too many medications can lead to adverse events in older adults. The Beers List of potentially inappropriate medications (PIMs) for use in the elderly was developed to help guide clinicians to safely prescribe medications. Moreover, in the United States, policies exist regulating the number of prescriptions nursing home residents may take. Few studies have compared family and geriatric providers' prescribing trends. The aim of this study was to compare prescribing by family and geriatric providers in a rural U.S. nursing home using a nonequivalent 2-group analysis design with data collected via retrospective chart audits (N=92). Nursing home residents in the nongeriatric provider group had fewer total comorbidities (U=p<.001) and were less likely to have congestive heart failure (χ2=p<.001), coronary artery disease (χ2=p<.001), and degenerative joint disease (χ2=p<.001). Despite this, on average, providers who were not geriatric trained prescribed twice as many drugs per patient (U=p<.001). The odds were significantly greater of being prescribed 9 or more drugs (odds ratio 13.15, 95% confidence interval 4.3-39.5) or being prescribed at least 1 PIM (odds ratio 6.25, 95% confidence interval 1.3-29.0) if the prescriber was not geriatric trained. The prevalence in this nursing home of receiving at least 1 PIM and polypharmacy were 36.9% and 72.8%, respectively. Promethazine accounted for 46.9% of all PIMs prescribed. Geriatric education appears to have influenced prescribing patterns at this facility, with geriatric-trained providers adhering more closely to evidence-based guidelines for older patients. As geriatric educational content is incorporated into nongeriatric specialty areas, pharmacology and prescribing competencies should be an area of ongoing focus for educators.