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Abstract
Objective: Traditionally, nursing homes have been associated with suboptimal drug therapy and drug-related problems (DRPs). In contrast, less is known about drug safety in homecare. The aim of this study was to describe and compare DRPs in older persons across two care settings: nursing homes and home nursing care.
Design: Cross-sectional study using descriptive and inferential statistics.
Setting: Nursing homes (n = 5) and home nursing care units (n = 8) across nine municipalities in the middle of Norway.
Participants: Multidisciplinary medication reviews for 61 nursing home residents and 93 patients receiving home nursing care performed over the 2013–2014 period, were mapped and examined (N = 154).
Main outcome measures: DRPs classified by a Norwegian Classification Tool.
Results: In all, 740 DRPs were detected in the total sample, 227 in nursing homes and 513 in home nursing care. DRPs were significantly higher among patients receiving home-based care (Mean =5.5) compared to patients in nursing homes (Mean =3.7, p = 0.002). Among the problem categories, the need for additional drug was most frequent in nursing homes (p = 0.001), while documentation discrepancies reached the highest numbers in patients receiving home nursing care (p = 0.000). Additionally, patients in home nursing care had more problems concerning adverse reactions (p = 0.060); however, this was not statistically significant. Differences in DRP categories leading to changes in the patients’ medication lists were also discovered.
Conclusions: The frequency of unclear documentation and adverse reactions found in the homecare setting is alarming. This is an important issue given the trend in aged care towards caring people in their own homes. Further research is warranted to explore how different care settings may influence the safety of pharmacotherapy for older persons.
Drug related problems are a significant cause of concern among patients receiving home nursing care as well as for patients living in nursing homes. The findings of this study showed that:
•Significantly more DRPs were detected among patients receiving home nursing care than patients living in nursing homes.
•While patients living in nursing homes were often undermedicated, documentation discrepancies were more frequent in home nursing care.
•DRP categories leading to changes on the medication lists differed between the settings.
Key Points
Acknowledgement
This study was supported by Centre for Development of Institutional and Home care Services in Nord-Trøndelag, and the County governor of Nord- Trøndelag. The authors are grateful to nurses who assisted the pharmacists in collecting the data in the municipalities.
Ethical approval
The administration of health and social care in each municipality received oral and written information about the study and gave written consent to participate. Initially, the study was presented to The Regional Committee for Medical Research Ethics. The Committee had no objections but defined this project outside their mandatory on healthcare research (Project number 2014/1140). They recommended application to the Norwegian Centre for Research Data who approved the handling of personal information (Project number: 40240).
Disclosure statement
The authors report no conflicts of interest.
Notes
Notes
1 Medication discrepancy –inconsistency between two or more medication lists
2 ATC, the Anatomical Therapeutic Chemical System. WHO. http://www.who.int/classifications/atcddd/en/
Additional information
Funding
Notes on contributors
Siri A. Devik
Siri Andreassen Devik, PhD, RN. Associate professor at Centre for care research, Mid-Norway, Steinkjer, Norway and at Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway.
Rose Mari Olsen
Rose Mari Olsen, PhD, RN. Associate professor at Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway.
Inger Lise Fiskvik
Inger Lise Fiskvik, MSc, RN. Manager of Homecare services in Stjørdal. During the project period she was employed at the management of Centre for Development of Institutional and Home care Services in Nord- Trøndelag, Stjørdal, Norway.
Terje Halbostad
Terje Halbostad, MSc, Pharmacist. Pharmacist at Hospital Pharmacy, Namsos Hospital, Norway.
Tone Lassen
Tone Lassen, MSc, Pharmacist. Pharmacist at Apotek 1, Malvik, Norway.
Natalia Kuzina
Natalia Kuzina, MSc, Pharmacist. Pharmacist at Apotek 1, Trondheim, Norway. M.Sc. - student at Department of Laboratory Medicine, Children’s and women’s Health, Norwegian University of Science and Technology, Trondheim, Norway during the project period.
Ingela Enmarker
Ingela Enmarker, Professor, RN. Professor at Centre for care research, Mid-Norway, and at Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.