PubMed Health⌕ Search

Biomedical subjects

M H Beers

Publications and source records attributed to M H Beers.

13 recordsLinked to original sources
PubMed1992

Inappropriate medication prescribing in skilled-nursing facilities.

OBJECTIVE: To quantify the appropriateness of medication prescriptions in nursing home residents. DESIGN: Prospective, cohort study. SETTING: Twelve nursing homes in the greater Los Angeles area. PARTICIPANTS: A total of 1106 nursing home residents. MAIN OUTCOME MEASURES: The appropriateness of medication prescriptions was evaluated using explicit criteria developed through consensus by 13 experts from the United States and Canada. These experts identified 19 drugs that should generally be avoided and 11 doses, frequencies, or durations of use of specific drugs that generally should not be exceeded. RESULTS: Based on the consensus criteria, 40% of residents received at least one inappropriate medication order, and 10% received two or more inappropriate medication orders concurrently; 7% of all prescriptions were inappropriate. Physicians prescribed a greater number of inappropriate medications for female residents. Regression analysis, corrected for clustering effects within facilities, showed that a greater number of inappropriate medication prescriptions were ordered in larger nursing homes. Inappropriate prescriptions were not related to the proportion of Medicaid (Medi-Cal) residents or the number of physicians practicing in the homes. CONCLUSIONS: Inappropriate medication prescribing in nursing homes is common. Female residents and residents of large nursing homes are at the greatest risk for receiving an inappropriate prescription.

Aged↗
PubMed1992

A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes.

BACKGROUND: Although psychoactive medications have substantial side effects in the elderly, these drugs are used frequently in nursing homes. Few interventions have succeeded in changing this situation, and little is known about the clinical effects of such interventions. METHODS: We studied six matched pairs of nursing homes; at one randomly selected nursing home in each pair, physicians, nurses, and aides participated in an educational program in geriatric psychopharmacology. At base line we determined the type and quantity of drugs received by all residents (n = 823), and a blinded observer performed standardized clinical assessments of the residents who were taking psychoactive medications. After the five-month program, drug use and patient status were reassessed. RESULTS: Scores on an index of psychoactive-drug use, measuring both the magnitude and the probable inappropriateness of medication use, declined significantly more in the nursing homes in which the program was carried out (experimental nursing homes) than in the control nursing homes (decrease, 27 percent vs. 8 percent; P = 0.02). The use of antipsychotic drugs was discontinued in more residents in the experimental nursing homes than in the control nursing homes (32 percent vs. 14 percent); the comparable figures for the discontinuation of long-acting benzodiazepines were 20 percent vs. 9 percent, and for antihistamine hypnotics, 45 percent vs. 21 percent. In the experimental nursing homes residents who were initially taking antipsychotic drugs showed less deterioration on several measures of cognitive function than similar residents in the control facilities, but they were more likely to report depression. Those who were initially taking benzodiazepines or antihistamine hypnotic agents reported less anxiety than controls but had more loss of memory. Most other measures of clinical status remained unchanged in both groups. CONCLUSIONS: An educational program targeted to physicians, nurses, and aides can reduce the use of psychoactive drugs in nursing homes without adversely affecting the overall behavior and level of functioning of the residents.

Aged↗
PubMed1992

A computerized system for identifying and informing physicians about problematic drug use in nursing homes.

With growing concern over the quality of medication use in nursing homes, physicians, administrators, pharmacists, and regulators are looking for effective and efficient methods to improve it. Pharmacy consultation alone appears to be ineffective in controlling the use of inappropriate drugs. We describe here a computerized drug utilization review system designed for use in nursing homes. The system evaluates the appropriateness of medication use by criteria developed through the consensus of experts in geriatrics and specifically designed to address the pharmacological needs of elderly, nursing home residents. The program not only determines the frequency of inappropriate prescriptions, but produces written, educational statements to be given to prescribing physicians. These statements can also be given to nurses to educate them about issues in geriatrics pharmacology. Additionally, the system produces medication order forms that may help focus physicians' attention on the need to evaluate drugs individually.

Clinical Pharmacy Information Systems↗
PubMed1992

Computer-assisted drug data collection.

Computerized systems for recording information about medication prescribing and use are important for studies in health services and pharmacoepidemiology. Such systems, if properly designed, can facilitate analysis as well as data collection. Although drug information systems exist for pharmacy service delivery applications, there are currently no descriptions of systems developed primarily for research applications in this area. This paper describes a computerized data collection system, developed for researchers, usable on portable equipment, and containing error checking features; the system has been extensively tested in over 850 study subjects taking part in a study of medication use in nursing homes that examines the impact of educational interventions for doctors and nurses on prescribing practices.

Clinical Pharmacy Information Systems↗
PubMed1992

Choosing quality of care measures based on the expected impact of improved care on health.

Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy of available treatments, and the current quality of care being provided. We use this model to select measures that could be used to measure the quality of care in health plans, but the proposed framework could also be used to select quality of care measures for other purposes or in other contexts (for example, to select measures for hospitals). Given the limited resources available for quality assessment and the policy consequences of better information on provider quality, priorities for assessment efforts should focus on those areas where better quality translates into improved health.

Breast Neoplasms↗
PubMed1991

Screening recommendations for the elderly.

BACKGROUND: Studies have documented the potential contributions of preventive health care programs. Yet little is known about which screening tests should be included in public health programs for older persons. This study offers recommendations regarding these tests. METHODS: The recommendations come from synthesizing the findings of the US Preventive Services Task Force, the literature, and the consensus of experts in geriatrics, gerontology, and health policy research. The literature was evaluated to identify methodologically sound studies of the prevalence of selected disorders and benefits and availability of screening procedures for those disorders. Experts from various fields specializing in the care of the elderly formed panels to assist in evaluating the literature and providing further information from gerontological and public health perspectives. RESULTS: We recommend vision testing for refractive error; inspection of the skin surface for fungal infection and skin cancer, drug eruptions, and xerosis; a history for symptoms of xerosis; audiometric testing for presbycusis; surveys for hearing loss; otoscopic inspection for cerumen impaction; dental examination for caries; measurement of blood pressure for hypertension; and breast examination and mammography for cancer. CONCLUSIONS: Our study suggests that these screening procedures are useful for public health screening programs. More information is needed on the effects of screening services on the health and functioning of older persons.

Aged↗
PubMed1991

Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine.

Increasing attention is being paid to inappropriate medication use in nursing homes. However, criteria defining the appropriate or inappropriate use of medication in this setting are not readily available and are not uniform. We used a two-round survey, based on Delphi methods, with 13 nationally recognized experts to reach consensus on explicit criteria defining the inappropriate use of medications in a nursing home population. The criteria were designed to use pharmacy data with minimal additional clinical data so that they could be applied to chart review or computerized data sets. The 30 factors agreed on by this method identify inappropriate use of such commonly used categories of medications as sedative-hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory agents, oral hypoglycemics, analgesics, dementia treatments, platelet inhibitors, histamine2 blockers, antibiotics, decongestants, iron supplements, muscle relaxants, gastrointestinal antispasmodics, and antiemetics. These criteria may be useful for quality assurance review, health services research, and clinical practice guidelines. The method used to establish these criteria can be used to update and expand the guidelines in the future.

Aged↗
PubMed1990

Potential adverse drug interactions in the emergency room. An issue in the quality of care.

STUDY OBJECTIVE: To determine how often emergency department physicians prescribe medications that can adversely interact with other medications that their patients are already taking, which patients are at highest risk for potential adverse reactions, and which medications most frequently lead to adverse interactions. DESIGN: Survey of elderly persons and other adults seeking care at an emergency department. PATIENTS: Four-hundred twenty-four randomly selected adults seeking care at a university-affiliated hospital emergency department. MEASUREMENTS AND MAIN RESULTS: We evaluated 424 randomly selected visits to a hospital emergency department made by 186 persons over age 65 and 238 younger adults; all of the subjects were discharged without hospital admission. Forty-seven percent of visits led to added medication, and in 10% of the visits in which at least one medication was added, a new medication added a potential adverse interaction. The interactions were determined by a computer program, were reviewed using explicit criteria, and were excluded if of uncertain or trivial clinical significance, rare, or not established for that specific drug. The number of medications used at presentation was the best predictor of whether a potential interaction would be introduced. CONCLUSIONS: In the emergency departments studied, a medication history was recorded on every patient and was available to physicians, but physicians did not routinely screen for potential drug interactions. Further safeguards are needed to protect patients from receiving medications that could produce adverse interactions.

Adult↗
PubMed1990

The accuracy of medication histories in the hospital medical records of elderly persons.

Medication histories written in medical records are important sources of information for clinicians and researchers. Medication histories in outpatient records are frequently inaccurate; the accuracy of the histories in hospital records has not previously been studied. We evaluated the accuracy of medication histories recorded in hospital medical records of 122 persons over the age of 65 at three sites, comparing the written record to a structured history obtained from the patient by the research staff. We defined an error as either the failure to record the use of a medication the patient claimed to use or the recording of a medication that the patient denied using. We found that 83% of all patients had at least one such error, and 46% had three or more. We reanalyzed the data excluding over-the-counter, tropical, and cold medications, and found that 60% of all patients still had at least one error, and 18% had three or more. Failure to record use in the record was more common than recording medications the patient denied using. There were no qualitative differences between hospitals or between the histories obtained by interns and attending physicians. This analysis suggests that medication histories in the hospital medical record are not accurate sources of information in elderly persons. Errors in the history may adversely affect clinical care; researchers relying on hospital medical records to determine medication use at the time of admission should first validate their data.

Aged↗
PubMed1990

Antihypertensive medications and depression.

The association between antihypertensive medications and depression has been recognised for over 40 years. More recently, our understanding of the role of neurotransmitters in the aetiology of depression has helped us understand how antihypertensive drugs cause depression. Biogenic amine depletion is now believed to underlie the organic nature of depression, and many of the drugs used to treat hypertension interfere with this system. There is now compelling evidence that both reserpine and alpha-methyldopa can induce or worsen depression through their actions on the central nervous system. beta-Blockers have also been implicated, but the data supporting the link between these drugs and depression are not as certain. Guanethidine, clonidine, hydralazine, and prazosin appear to pose little risk in causing depression, although rare occurrences have been reported. Diuretics, calcium channel blockers, and angiotensin converting enzyme (ACE) inhibitors appear to have the lowest association with depression and are therefore the drugs of choice when depression is a risk. Physicians should know which drugs introduce the risk of causing or worsening depression. The wide array of medications now available to treat hypertension offers alternatives that pose low risk. All patients receiving medication to treat hypertension should be evaluated periodically for depression, and if depression occurs, medication should be suspected as playing a role in its aetiology.

Antihypertensive Agents↗
PubMed1989

Influence of hospitalization on drug therapy in the elderly.

In order to determine whether acute hospitalization leads to changes in the medications used by the elderly after discharge, we studied the medications used at admission and discharge for 197 elderly subjects admitted to one hospital. We found that 40% of all admission medications were discontinued by discharge and 45% of all discharge medications were newly started during the hospitalization. Although the number of drugs used did not increase significantly from admission to discharge (4.50 to 4.80, P = .128), the number of narcotics, laxatives, and antibiotics increased significantly. For those elderly subjects admitted to the hospital taking less than the average number of medications, the overall use of medication increased from admission to discharge (2.89 to 3.75, P less than .0001). These "low users" were discharged on more benzodiazepines, narcotics, laxatives, antibiotics, and cardiac medications. Our data suggest that during hospitalization admission medications are discontinued and new medications are started in large numbers and that these changes are accompanied by a tendency towards the increased use of certain categories of medications. These changes may place the elderly patient at increased risk of polypharmacy and its complications.

Aged↗
PubMed1989

Risk factors in geriatric drug prescribing. A practical guide to avoiding problems.

Although the use of medication has helped to cure and control disease, it has also led to serious iatrogenic illness. Toxicity is most common and severe in the elderly. Confusion, falls, depression, sedation, deterioration of function, and urinary incontinence and retention are frequently the manifestation of that toxicity. Normal ageing places older patients at risk because of changes in metabolism, distribution, and excretion of drugs, and sensitivity to drug effects is often greater in the elderly. Disease and the interactions of other drugs can increase the incidence and severity of side effects. Certain drugs should be avoided in the elderly. Those that are long acting and require hepatic metabolism, those with strong anticholinergic properties, and those that are highly sedating tend to cause the most problems. In every case, physicians must weigh the potential benefit of prescribing against the potential risk.

Aged↗