Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs

Abstract

Purpose: to examine and compare the quality of drug prescribing for older patients in nursing homes and home nursing services. Methods: Cross-sectional study comprising 11 254 patients aged ≥65 years in nursing homes (n = 2986) and home nursing services (n = 8268). Potentially inappropriate medications were identified by using the Norwegian General Practice criteria and drug–drug interactions through a Norwegian Web-based tool. The impact of care setting on exposure to selected drug groups, potentially inappropriate medications, and drug interactions was calculated, adjusting for patients’ age, gender, and number of drugs used. Results: patients in nursing homes and home nursing services used on average 5.7 (SD = 2.6) multidose dispensed regular drugs. 26% used at least one potentially inappropriate medication, 31% in nursing homes and 25% in home nursing services, p<.001. Concomitant use of three or more psychotropic and/or opioid drugs was the criterion most commonly identified in nursing homes (18%) and home nursing services (9%), p<.001. Compared with nursing homes, more patients in home nursing services used cardiovascular drugs and fewer patients used psychotropic drugs. Altogether, 8615 drug–drug interactions were identified in 55% of patients, 48% in nursing homes and 57% in home nursing services, p<.001. Conclusions: there are significant differences in the quality of drug prescribing in nursing homes compared with home nursing services. Explanations as to why these differences exist need to be further explored.