Medication Practices for the Medication Practices for the Elderly Elderly in U.S. Nursing Homes in U.S. Nursing Homes Lisa L. Dwyer, MPH Lisa L. Dwyer, MPH Robin E. Remsburg, PhD, APRN, BC Robin E. Remsburg, PhD, APRN, BC Division of Health Care Statistics Division of Health Care Statistics National Center for Health Statistics National Center for Health Statistics AcademyHealth Annual Research Meeting 2006: Seattle, AcademyHealth Annual Research Meeting 2006: Seattle, WA WA June 26, 2006 June 26, 2006
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Medication Practices for the Elderly in U.S. Nursing Homes
Medication Practices for the Elderly in U.S. Nursing Homes. Lisa L. Dwyer, MPH Robin E. Remsburg, PhD, APRN, BC Division of Health Care Statistics National Center for Health Statistics AcademyHealth Annual Research Meeting 2006: Seattle, WA June 26, 2006. Introduction. - PowerPoint PPT Presentation
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Medication Practices for the Elderly Medication Practices for the Elderly in U.S. Nursing Homes in U.S. Nursing Homes
Lisa L. Dwyer, MPHLisa L. Dwyer, MPH
Robin E. Remsburg, PhD, APRN, BC Robin E. Remsburg, PhD, APRN, BC
Division of Health Care StatisticsDivision of Health Care Statistics
National Center for Health StatisticsNational Center for Health Statistics
AcademyHealth Annual Research Meeting 2006: Seattle, WAAcademyHealth Annual Research Meeting 2006: Seattle, WA
June 26, 2006June 26, 2006
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IntroductionIntroduction
Previous study reports that medication use is Previous study reports that medication use is
highest among the institutionalized elderly.highest among the institutionalized elderly.
• comorbiditiescomorbidities
• pharmacodynamics and pharmacokineticspharmacodynamics and pharmacokinetics
Greater potential for adverse events Greater potential for adverse events
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IntroductionIntroduction
Current estimates of the number and Current estimates of the number and
types of medications taken by the types of medications taken by the
nursing home elderly are lacking.nursing home elderly are lacking.
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Research QuestionsResearch Questions
What was the average number of What was the average number of medications taken by elderly nursing home medications taken by elderly nursing home residents?residents?
What were the most frequent therapeutic What were the most frequent therapeutic classes taken by these residents?classes taken by these residents?
What percentage of residents took What percentage of residents took benzodiazepines and barbiturates before the benzodiazepines and barbiturates before the Medicare Part D implementation? Medicare Part D implementation?
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2004 National Nursing Home Survey2004 National Nursing Home Survey
Survey itemsSurvey items
• medications taken 24 hrs before facility interviewmedications taken 24 hrs before facility interview standing or routine medications, or PRNsstanding or routine medications, or PRNs
up to 25 medicationsup to 25 medications
• medications taken regularly but not 24 hrs medications taken regularly but not 24 hrs before facility interviewbefore facility interview up to 25 medicationsup to 25 medications
• reason medications were prescribedreason medications were prescribed
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2004 National Nursing Home Survey2004 National Nursing Home Survey
Medication dataMedication data
• found in medication administration recordsfound in medication administration records
did not collect dosage, frequency, routedid not collect dosage, frequency, route
• provided by respondent during facility interviewprovided by respondent during facility interview
• entered into CAPI system by interviewerentered into CAPI system by interviewer
• were appended with drug characteristicswere appended with drug characteristics
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2004 National Nursing Home Survey2004 National Nursing Home Survey
Drug characteristics appendedDrug characteristics appended
• generic namegeneric name
• ingredientsingredients
• therapeutic classestherapeutic classes
• composition statuscomposition status
• prescription statusprescription status
• DEA statusDEA status
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2004 National Nursing Home Survey 2004 National Nursing Home Survey
Results: Results:
• 1.3 million elderly current residents1.3 million elderly current residents
26% male, 74% female26% male, 74% female
mean age = 85 y.o. (standard error = 0.11)mean age = 85 y.o. (standard error = 0.11)
2004 National Nursing Home Survey 2004 National Nursing Home Survey SummarySummary
• Preliminary analysis reveals that many residents Preliminary analysis reveals that many residents took > 9 medications.took > 9 medications.
• Metabolic/nutrients, pain relievers, gastrointestinal Metabolic/nutrients, pain relievers, gastrointestinal agents, and CNS drugs were taken frequently.agents, and CNS drugs were taken frequently.
• Residents who took benzodiazepines (13%) may be Residents who took benzodiazepines (13%) may be affected by the Medicare Part D exclusions; affected by the Medicare Part D exclusions; residents who took prescription vitamins/minerals residents who took prescription vitamins/minerals and nonprescription products may be affected as and nonprescription products may be affected as well.well.
Preliminary Results.
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2004 National Nursing Home Survey 2004 National Nursing Home Survey
Significance/relevance Significance/relevance
• Patient safety Patient safety
• Evaluation of Medicare Part D implementationEvaluation of Medicare Part D implementation
health outcomes of residentshealth outcomes of residents
change(s) in clinical practicechange(s) in clinical practice
policy makers’ response policy makers’ response
Preliminary Results.
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2006 NCHS Data Users Conference2006 NCHS Data Users Conference