Long-Term Care in the News
| Geriatric Times |
 |
May/June 2001 |
|
Vol. II |
|
Issue 3 |
Survey Examines Medication Usage in Nursing Facilities
The completion of a recent national survey has resulted in medication usage
patterns in nursing facilities and benchmark data covering a total of eight
years. The comparative data, which were provided by consultant pharmacists,
will help improve the quality of life for patients in nursing facilities.
Investigators Dianne E. Tobias, Pharm.D., F.A.S.C.P., and Mark Sey, Pharm.D.,
F.A.S.C.P., conducted similar surveys in 1993, 1994 and 1997; the results of
the 2000 survey were published in the January issue of The Consultant
Pharmacist.
In the most recent survey, 109 consultant pharmacists provided medication
usage data on 33,301 residents of 328 nursing facilities in 25 states. The
study examined the use of routinely scheduled and as-needed general
medications, psychotherapeutic medications (broken into four
categories_antidepressants, antipsychotics, anxiolytics and hypnotics) and
"other medications" for behavior. Data were gathered from licensed nursing
facilities, as defined under the Omnibus Budget Reconciliation Act of 1987;
thus, specialized facilities (e.g., intermediate care facilities for the
developmentally disabled [ICF-DD], intermediate care facilities for the
mentally retarded [ICF-MR], assisted living facilities, board and care/foster
care facilities, dementia care/Alzheimer units, and facilities licensed as
psychiatric facilities) were excluded.
According to the results, there was an increase in the average number of
routine general medication orders, from 5.85 per resident in 1997 to 6.69 per
resident in 2000. Twenty-seven percent of all residents surveyed had nine or
more routinely scheduled medications concurrently, a significant increase over
18.2% in 1997. Antidepressants were the most commonly prescribed
psychotherapeutic medication (34.5%±12.1%) followed by antipsychotics
(16.9%±7.2%) and hypnotics (2.3%±2.5%). In comparison with the
1997 survey, the largest increases were found in routine general medication
use, the number of residents receiving nine or more routine medications, and in
use of antidepressants and antipsychotics.
This series of studies also provided regional trends in medication usage.
Such benchmark data allow for an increase in awareness of disorders common
among the elderly, treatment of undertreated conditions, and a focus on
wellness and preventive health measures in nursing facilities -- RG
Short-Term Antibiotics Effective for Some Infections
At last year's 40th Interscience Conference on Antimicrobial Agents and
Chemotherapy (ICAAC), organized by the American Society for Microbiology, the
latest basic and clinical research on infectious diseases was discussed. The
conference included a symposium during which presenters outlined a rationale
for abbreviated courses of antimicrobial therapy, giving specific
recommendations for a variety of infections.
An abbreviated course of antimicrobial therapy reduces the amount of
antibiotic used, and reduces the risk for development of antibiotic resistance.
Shorter courses of antibiotics can be more economical. In addition, patient
compliance is improved when courses of antibiotics were shortened.
A number of U.S. studies over the past 40 years have shown that, given a
10-day course of oral penicillin, only 8% to 68% of patients were still using
the medication by day 9 of treatment. In effect, they are already on a
shortened course treatment.
Researchers at the conference also presented a review of 20 studies of
shortened courses of antibiotics for streptococcal pharyngitis. In this review,
it was found that five days of treatment with either amoxicillin, any of a
number of oral cephalosporin antibiotics or oral azithromycin was as effective
as the gold standard-10 days of oral penicillin.
Treatment for bacterial endocarditis is usually four to six weeks of high
levels of a bactericidal agent, often in combination with another medication.
However, there is now extensive evidence that two weeks of treatment with
penicillin and streptomycin is an effective treatment for bacterial
endocarditis as well.
Fifteen days of ceftriaxone therapy has been shown to be as effective as
standard treatment for streptococcal endocarditis. Ceftriaxone combined with
gentamicin for two weeks showed a similar outcome to four weeks of monotherapy
with ceftriaxone. In patients with penicillin-susceptible bacterial
myocarditis, equivalent relapse rates of 0% to 4% were seen in those treated
with penicillin and an aminoglycoside for 14 days, ceftriaxone for 28 days, or
ceftriaxone and an aminoglycoside for 14 days.
The presenters concluded that two weeks can be considered a standard for
selected patients with susceptible strains of streptococci or for patients with
isolated right-sided bacterial endocarditis with staphylococci. The prospects
for shortening therapy to less than 10 days, however, appear unlikely.
Additional information on these presentations and others from the conference
is available at the American Society of Microbiology's Web site
<www.asmusa.org/mtgsrc/40icaac.htm>-EAD
Registries: A Simple Approach To Enhancing Health Care
Following on the coattails of national foundations such as Myasthenia Gravis
Foundation of America Inc., The Arthritis Society and United Mitochondrial
Disease Foundation, all of which have organized nationwide patient registries,
health care practitioners are realizing the value of creating their own
in-house registries of patients suffering from chronic diseases. These
registries will allow doctors to proactively keep track of their patients'
health status and chronic conditions. Implementing such a registry can enhance
overall patient health, care and satisfaction.
Michael Hindmarsh, manager of clinical improvement programs at Seattle-based
Group Health Cooperative, told the press that registries are essential to
taking charge of the care of chronically ill patients. Hindmarsh, who has been
using patient registries and training others to use them since the early 1990s,
insisted that practices of any size can build usable registries without
investing a lot of time or money in the set-up process. An easy first step is
cross-checking ICD-9 codes, prescriptions, lab data and billing information to
determine which patients should be included in a registry of chronic disease
patients, he said. This information can then be used to create a simple
registry of vital patient information using a database program.
After the initial set-up, the maintenance of such databases is minimal.
Before a visit, the registry can be reviewed and printed and the patient
information can be placed with their chart. The health care provider is thus
able to ensure that the applicable clinical measures, tests and referrals are
performed. Once a clinical visit is complete, the registry can be immediately
updated with the test results.
Health care practitioners can use patient registries to improve the care of
patients with chronic diseases in many ways. They can use these registries as a
one-stop method of determining when the patient is due for a clinic visit, what
tests need to be updated, what current and past treatment methods have been
attempted, and treatment success rates, among other uses. This close monitoring
can help alert the practitioner to changes in health status that might be
warning signs, thus enabling earlier prevention and reduction in potential
complications and resultant hospital emergency department visits.
For practices that have re-engineering budgets, there are professionally
designed software packages available, such as CogniMed Inc.'s CareSystem.
Nationwide, linked registries are being created for specific entities, such as
the Missing Patient Registry. This registry is used by the U.S. Department of
Veterans Affairs in assisting their medical center personnel in tracking and
locating missing patients.
As registries such as those previously mentioned grow and expand to include
additional organizations, the use of in-house registries_when linked to those
that are nationwide_will offer a proactive alternative to the usual reactive
approach taken in non-emergency health care_RR