Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards

Figures & data

Table I. Potentially inappropriate medications (PIMs) identified on admission to and discharge from intermediate care nursing home unit (INHU) and hospital ward (HW).

NORGEP criteria	INHU admission (n = 157) %	INHU discharge (n = 157) %	HW admission (n = 133) %	HW discharge (n = 133) %	All patients admission (n = 290) %	All patients discharge (n = 290) %
1. Amitriptyline	1.3	0.6	2.3	2.3	1.7	1.4
2. Doxepin	0.6	0.6	0	0	0.3	0.3
3. Clomipramine	0.6	0.6	0	0	0.3	0.3
4. Trimipramine	0	0	0	0	0	0
5. Chlorpromazine^1	0	0	0	0	0	0
6. Chlorprothixene	0	0	0	0	0	0
7. Levomepromazine	0	0	0	0	0	0
8. Prochlorperazine	1.3	1.9	3.0	3.0	2.1	2.4
9. Diazepam	4.5	4.5	5.3	11.3	4.8	7.6
10. Nitrazepam	4.5	3.2	2.3	3.0	3.4	3.1
11. Flunitrazepam	0	0	0	0	0	0
12. Oxazepam 30 mg/24 h	1.9	5.7	0	0	1.0	3.1
13. Zopiclone 7.5 mg/24 h	0.6	0.6	0	0	0.3	0.3
14. Carisoprodol^1	0	0	0	0	0	0
15. Dextropropoxyphene	2.5	2.5	0.8	0.8	1.7	1.7
16. Theophylline	0.6	0.6	1.5	1.5	1.0	1.0
17. Sotalol	0	0	0	0	0	0
18. Dexchlorfeniramine	0	0.6	0	0	0	0.3
19. Promethazine	0	0	0	0	0	0
20. Hydroxyzine	0.6	1.9	0	0	0.3	1.0
21. Alimemazine	0	0	0	1.5	0	0.7
22. Warfarin + NSAID	0.6	0.6	0	0	0.3	0.3
23. Warfarin + ofloxacin or ciprofloxacin	0	0	1.5	2.3	0.7	1.0
24. Warfarin + erythromycin or clarithromycin	0	0	0	0	0	0
25. Warfarin + SSRI	1.9	3.2	3.8	3.0	2.8	3.1
26. NSAID/coxib + ACE inhibitor/ARB	2.5	5.1	1.5	1.5	2.1	3.4
27. NSAID + diuretic	1.3	3.2	0	2.3	0.7	2.8
28. NSAID + glucocorticoid	0	1.3	0	1.5	0	1.4^*
29. NSAID + SSRI	0	3.2	0	0.8	0	2.1**
30. Erythromycin or clarithromycin + statin	1.3	0	0	0	0.7	0
31. ACE inhibitor + potassium or potassium-sparing	1.3	1.3	3.8	5.3	2.4	3.1
32. Fluoxetine or fluvoxamine + TCA	0	0	0	0	0	0
33. Beta blocker + cardioselective calcium antagonist	0	0	0	0	0	0
34. Diltiazem + lovastatin or simvastatin	0.6	0.6	0	0	0.3	0.3
35. Erythromycin or clarithromycin + carbamazepine	0	0	0	0	0	0
36. Concomitant prescription of three or more drugs within the groups centrally acting analgesics, antipsychotic agents, antidepressants and/or benzodiazepines	4.5	14.0*	2.3	12.8*	3.4	13.4**
Any NORGEP criterion	25.5	33.1	22.6	36.8*	24.l	34.8*

Notes: NSAID = non-steroidal anti-inflammatory drug; SSRI = selective serotonin reuptake inhibitor; ACE angiotensin-converting enzyme; ARB = angiotensin-receptor blocker; TCA = tricyclic antidepressant. ¹Withdrawn from the Norwegian market. Chi-squared test with Yates’ correction for changes from admission to discharge; Fisher if < 5 expected cases; *p < 0.05; **p < 0.01. Logistic regression was not conducted due to multiple empty cells, and very small numbers in most remaining cells.

Table II. Prevalence of drug use on admission and discharge, and changes in drug use during stay, within and between study groups.

ATC code	Drug group	All patients admission (n = 290) %	All patients discharge (n = 290^1) %	HW discharge (n = 133) %	INHU discharge (n = 157) %	Comparison of the change in drug use from admission to discharge between HW and INHU^2
						Odds ratio	95% Confidence interval
A02	Drugs for acid-related disorders	20.3	24.5	26.3	22.9	0.80	0.32–2.17
A03	Drugs for functional gastrointestinal disorders	1.4	20.7**	21.8	19.7	0.85	0.47–1.53
A06	Laxatives	12.4	45.2**	41.4	48.4	1.57	0.94–2.62
A11	Vitamins	10.0	15.5*	15.0	15.9	1.70	0.61–4.64
A12	Minerals	20	27.9*	26.3	29.3	1.03	0.48–2.23
B01	Antithrombotic agents	59.0	64.5	72.2	58.0	0.36	0.16–0.78
B03	Anti-anaemic preparations	14.1	19.0	16.5	21.0	1.44	0.54–3.88
C01	Cardiac therapy	23.1	25.2	26.3	24.2	0.76	0.29–2.00
C03	Diuretics	39.7	42.1	45.9	3.8	0.76	0.26–2.18
C07	Beta-blocking agents	40.0	42.4	44.4	40.8	0.44	0.15–1.35
C08	CaŸ+channel blockers	16.9	18.6	21.8	15.9	4.16	0.91–19.02
C09	Agents acting on the renin-angiotensin system	38.6	36.6	36.8	36.3	1.12	0.48–2.59
C10	Lipid-modifying agents	27.6	29.0	27.1	30.6	0.89	0.12–6.51
H03	Thyroid therapy	15.5	25.9	12.0	17.8	–
J01	Antibacterial agents for systemic use	10.0	21.4**	29.3	14.6	0.32	0.17–0.60
M01	Anti-inflammatory and anti-rheumatic products, including non-steroids	4.1	9.7**	6.8	12.1	0.67	0.28–1.61
M others	Musculoskeletal system; other drugs	13.4	15.9	18.0	14.0	1.35	0.32–5.69
N02A	Analgesics: opioids	15.9	49.0**	51.1	47.1	0.91	0.55–1.52
N02B	Analgesics: other analgesics and antipyretics	15.9	60.3**	51.9	67.5	2.20	1.32–3.67
N05A	Psycholeptics: antipsychotics	3.8	5.5	6.0	5.1	1.0	0.25–3.91
N05B	Psycholeptics; anxiolytics	11.0	19.0**	18.0	19.7	1.37	0.59–3.18
N05C	Psycholeptics: hypnotics and sedatives	23.8	49.0**	47.4	50.3	1.19	0.68–2.01
N06A	Psychoanaleptics: antidepressants	16.2	17.6	15.0	19.7	1.65	0.38–7.16
R03	Drugs for obstructive airway disease	14.8	19.3	16.5	21.7	1.32	0.48–3.60
R05	Cough and cold preparations	3.8	17.9**	13.5	21.7	2.24	1.09–4.61
S01	Ophthalmologicals	11.7	17.6*	18.0	17.2	2.59	0.89–7.50

Notes: INHU = intermediate nursing home unit; HW = hospital ward. ¹Test of overall change in proportion of drug use from admission to discharge (chi-squared test, Fisher if < 5 expected cases). ²Logistic regression, adjusted for age, sex, and drugs used on admission (reference: INHU). *p < 0.05, *p < 0.01.

Table III. Drug–drug interactions identified on admission to and discharge from intermediate-care nursing home unit (INHU) and hospital ward (HW).

Drug–drug interaction (DRUID) severity scale	HW admission (n = 133) %	HW discharge (n = 133) %	INHU admission (n = 157) %	INHU discharge (n = 157) %	All patients admission (n = 290) %	All patients discharge (n = 290) %
A	31.6	44.4^*	24.8	39.5^**	27.9	41.7^**
B	39.8	54.1^*	40.1	46.5	40.0	50.0^*
C	8.3	12.8	6.4	11.5	7.2	12.1^*
D	0	0	1.3	1.3	0.7	0.7
Any drug–drug interaction	54.9	67.7^*	52.9	66.9^**	53.8	67.7^**

Notes: A = of academic interest; B = take precautions; C = should be administered 2–3 hours apart; D = should not be combined. Chi-squared test for changes from admission to discharge; Fisher if < 5 expected cases; ^*p < 0.05; ^**p < 0.01. Logistic regression did not reveal significant differences between study groups; results are not shown.