Drug prescribing for the elderly outpatient and for those confined to convalescent hospitals. How the new OBRA laws will change some established habits.

Families as well as state and federal inspectors have long complained of unnecessary drugs prescribed by physicians, especially antipsychotic drugs, used as chemical restraints in skilled nursing facilities. The US Congress passed the Omnibus Budget Reconciliation Act of 1987 (OBRA), also commonly referred to as the Nursing Home Reform Act, to prevent inappropriate prescribing of medications in long-term care facilities that receive funds from Medicare and Medicaid. The regulations became effective October 1, 1990 and were enforced starting in 1991. Future regulations regarding drug labeling of all prescriptions, including biologics, are being proposed by the Food and Drug Administration for the protection of the elderly from adverse drug reactions in the community. A survey was performed in a 132-bed convalescent hospital in Los Angeles to assess the most frequent types of drugs ordered and the most frequent diseases found in this facility. The study revealed the most frequent diagnosis and drugs ordered on admission to the facility from acute facilities, home, and board and care facilities. The diagnosis differed, and the drugs the patients were taking differed markedly at the time of admission. Attending physicians in the convalescent hospital changed many of the drugs to meet the needs of the convalescent hospitals as well as the new OBRA regulations. Future prescribing habits of physicians will be modified in convalescent hospitals, and the results will need further studies to assess its effect on patient care.