Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway

Figures & data

Table 1. Baseline characteristics of the long-term care patients participating in the medication review project.

Variables	All patients	Age <80 years	Age 80–89 years	Age ≥90 years
Patients with MR, n (%)	2465 (100)	463 (18.8)	1023 (41.5)	979 (39.7)
Gender, n (%)
Female	1828 (74.2)	274 (59.2)	752 (73.5)	802 (81.9)
Male	630 (25.6)	188 (40.6)	267 (26.1)	175 (17.9)
Number of drugs, n (%)
Regular drugs	16,634 (69.3)	3324 (68.3)	6960 (70.7)	6350 (68.3)
Prn drugs	7369 (30.7)	1540 (31.7)	2881 (29.3)	2948 (31.7)
Total drugs	24,003 (100)	4864 (100)	9841 (100)	9298 (100)
Mean drugs/patient(±SD)
Regular drugs	6.8 ± 3.3	7.2 ± 3.6	6.8 ± 3.3	6.5 ± 3.1
Prn drugs	3.0 ± 2.1	3.3 ± 2.3	2.8 ± 2.0	3.0 ± 2.2
Total drugs	9.8 ± 4.4	10.5 ± 4.7	9.6 ± 4.3	9.5 ± 4.3

Missing gender data (7 patients).

The mean numbers of drugs by gender were similar: 6.8 for regular drugs and 3.0 for prn drugs.

Table 2. Categories of drug-related problems and the three drugs (therapeutic groups) most commonly involved in the problem listed.

Drug-related problems (n = 6158)		The three drugs most commonly involved in the drug-related problems listed
Problem	n (%)	No. 1	n of drugs	No. 2	n of drugs	No. 3	n of drugs
Unnecessary drug	2680 (43.5)	Hypnotics/sedatives	296	Opioids^b	249	Anxiolytics	213
Excess dosing	770 (12.5)	Paracetamol	108	Antacid drugs	103	Hypnotics/sedatives	92
Monitoring of drug use required	680 (11.0)	Antidepressants	103	Antidementia drugs	48	Renin–angiotensin system	46
Inappropriate drug choice	503 (8.2)	Opioids	80	Anxiolytics	56	Hypnotics/sedatives	43
Need for additional drug	453 (7.4)	Anti-anaemia drugs^a	130	B-complex vitamins	62	Paracetamol	43
Adverse drug reaction	287 (4.7)	Hypnotics/sedatives	37	Anxiolytics	32	Antipsychotics	28
Drug–drug interactions	271 (4.4)	Antidepressants	124	Antithrombotic agents	66	Opioids	50
Under-dosing	169 (2.7)	Paracetamol	27	Opioids	26	Thyroid therapy	23
Suboptimal dosing/formulation	141 (2.4)	Beta-blockers	21	Paracetamol	18	Hypnotics/sedatives	6
Other	127 (2.0)	Anti-thrombotic agents^d	17	Opioids	7	Anxiolytics	7
Inappropriate drug use	77 (1.2)	Paracetamol	12	COPD drugs^c	9	Opioids	4

^a iron supplements, B₁₂ vitamin and folate.

^b ATC-N02A comprising weak opioids (codeine, tramadol) and strong opioids.

^c Chronic obstructive pulmonary disease drugs comprising adrenergic/anti-cholinergic drugs (systemic or inhalation use) and glucocorticoids (inhalation use).

^d ATC-B01A (mainly warfarin, acetylsalicylic acid and heparin).

Table 3. Interventions to resolve drug-related problems (DRPs) and the three drugs (therapeutic groups) most commonly involved in changes to the drug therapy regimens.

Interventions to resolve DRPs (n = 6283)		The three drugs most commonly involved in the interventions listed
Intervention	n (%)	No. 1	n of drugs	No. 2	n of drugs	No. 3	n of drugs
Stop drug	2662 (42.4)	Opioids^a	293	Hypnotics/sedatives	242	Anxiolytics	217
Monitor drug use	1455 (22.7)	Antidepressants	182	Antithrombotic agents^b	112	Hypnotics/sedatives	84
Dose adjustment	1141 (17.8)	Hypnotics/sedatives	131	Paracetamol	128	Antacid drugs^c	112
Drug switch	438 (6.8)	Opioids	68	Hypnotics/sedatives	41	Diuretics	32
Start new drug	436 (6.8)	Anti-anaemia drugs^d	124	B-complex vitamins	62	Paracetamol	41
Other	151 (2.4)	Paracetamol	17	Beta-blockers	13	Hypnotics/sedatives	8

^a ATC-N02A comprising weak opioids (codeine, tramadol) and strong opioids.

^b ATC-B01A (mainly warfarin, acetylsalicylic acid and heparin).

^c Mainly proton pump inhibitors.

^d Iron supplements, B₁₂ vitamin and folate.

Table 4. The proportion of patients using regular drugs before and after the medication review and reductions in drug use after the medication review.

	All patients, n = 2465 % of patients using the drug
Therapeutic group	Before MR	After MR	Reduction (95% CI)^a
Laxatives	82.0	81.6	0.4
Antithrombotic agents	46.2	43.5	2.7 (–1.0–5.5)
Paracetamol	44.5	43.7	0.8
Antidepressants	37.2	33.3	3.9 (1.2–6.6)
Opioids	34.3	33.1	1.2
Hypnotics/sedatives	32.6	28.9	3.7 (1.1–6.3)
Diuretics	32.0	27.3	4.7 (2.2–7.2)
Anti-anaemia drugs	27.1	26.2	0.9
Beta-blockers	24.9	23.9	1.0
Anxiolytics	21.4	20.2	1.2
Antacid drugs	21.0	18.9	2.1 (–0.1–4.3)
Osteoporosis drugs	20.3	19.5	0.8
Thyroid therapy	20.2	20.2	–
COPD drugs	18.8	17.4	1.4
Antipsychotics	18.3	16.5	1.8 (–0.3–3.9)
Drugs for glaucoma	15.6	15.4	0.2
Antiepileptic drugs	12.4	12.4	–
Drugs used in diabetes	11.9	11.4	0.5
Digitalis and nitrates	11.9	10.8	1.1
Antidementia drugs	11.6	10.5	1.1
Antibiotics	9.8	9.1	0.7
Calcium blockers	8.6	7.5	1.1
Antihistamines	6.4	5.0	1.4
Lipid modifying agents	6.0	5.1	0.9
Oral corticosteroids	6.2	6.0	0.2
Anti-Parkinson drugs	5.4	5.2	0.2
Others	86.5	77.7	8.8 (6.4–11.2)
Total n of drugs	16,634	15,563	6.4 (2.2–4.4)

^a The 95% confidence interval is shown only if significant.

Table 5. The proportion of patients using pro re nata drugs before and after the medication review and reductions in drug use after the medication review.

	All patients, n = 2465 % of patients using the drug
Therapeutic group	Before MR	After MR	Reduction (95% CI)^a
Paracetamol	49.0	48.0	1.0
Anxiolytics	48.1	41.0	7.1 (4.3–9.9)
Opioids	38.9	27.7	11.2 (8.6–13.8)
Laxatives	29.1	26.3	2.8 (0.3–5.3)
Hypnotics/sedatives	24.9	19.1	5.8 (3.5–8.1)
Expectorants	12.9	10.2	2.7 (0.9–4.5)
Nitrates	12.7	11.8	0.9
Metoclopramide	12.5	9.0	3.5 (1.8–5.2)
NSAIDs	6.8	3.9	2.9 (1.6–4.2)
Diuretics	5.7	5.1	0.6
Drugs used in diabetes	5.2	5.0	0.2
Antipsychotics	4.9	3.4	1.5 (0.4–2.6)
Others	48.0	42.2	5.8 (1.7–9.9)
Total n of drugs	7369	6214	15.3 (6.6–10.0)

^aThe 95% confidence interval is shown only if significant.