[Impact of a program to improve appropriate prescribing of medications in residential facilities for older persons. Results after one year].

OBJECTIVE

To evaluate the impact after one year of a program to improve appropriate prescribing of medications, medical care products and supplies at a group of residential centers for older persons.

DESIGN

Multicenter, controlled, quasi-experimental, before-after study of all outpatient prescriptions charged from each center to the Catalonian Health Service during the study period (reference year 2001, monitoring year 2002).

SETTING

A total of 107 residential centers in the Barcelonés Norte y Maresme (Barcelona) health region.

PARTICIPANTS

After situation analysis the centers were divided into two groups: intervention (n=21) and control (n=86). A total of 4789 older persons were residents at participating centers during the study. Interventions. The actions carried out in the intervention group were: a). letter describing the program; b). face-to-face interview to provide information; c). distribution of printed information about the study's aims and the indicators recorded, and d). monitoring with several follow-up interviews.

MAIN MEASURES

We recorded quantitative indicators (general, specific and urinary incontinence products), qualitative indicators (use of medications with high intrinsic pharmacological value and generic pharmaceutical specialties) and relative drug use. The data were analyzed with a program written for Microsoft Access.

RESULTS

In the intervention group we found that pharmaceutical costs were contained, a result we attributed to the greater efficiency achieved with the intervention (interannual increase of 0.7% in the reference period to 16.2% in the monitoring period; P=.000). The contribution of urinary incontinence supplies to cost reductions was noteworthy. Total costs in terms of numbers of packages dispensed for all therapeutic subgroups decreased by 4.8% (P=.000). The use of generic pharmaceutical specialties increased by from 7.9% to 13.1%, and the results for qualitative indictors for antiasthmatics and recommended NSAIDs also revealed improvements in prescribing quality.

CONCLUSIONS

The preliminary results of the program show it to be effective in improving the efficiency of drug prescribing at participating nursing homes. The research method was useful in promoting the rational use of medications and improving the quality of prescribing practices.