Objective: The number of elderly people is steadily increasing and with that the number of demented people. In Sweden 9% of the population is above 75 years but is consuming 38% of the total amount of drugs. This equivalent one forth of the gross costs for the pharmacotherapy in Sweden. Moreover nearly 40% of the elderly are prescribed 10 ore more different drugs. Considering the elderly being the most sensitive and vulnerable to pharmacological interventions, interactions and side effects a more restrictive policy would be desirable. Especially is there a high consumption of various drugs in patients living in nursing homes, and aligned with there is also a risk of parallel therapy of drugs originating from same pharmacological class. Therefore both for the patient and the society, it can be of value to carry out a drug revision in nursing homes.
Design: Drug revision in nursing home with focus on health economics. The revision team being the physician responsible for the nursing home and a college of him together with a pharmacist. The nurse responsible for the nursing home recording the outcome of the actions taken performs a quality control. All corrections are made in agreement with the responsible physician.
Materials and Methods: Three nursing homes with a total of 129 patients were investigated. The pharmacist made an inventory of all the drugs used in all the patients. All potential interactions and eventual use of parallel drugs from the same class were identified. After the revision the team made suggestions of changes and the responsible physician made the final decision of change. The patients were followed up and corrections were made.
Results: A total of 196 corrections of the medication were made on the 129 patients. Of these corrections, 75% were on daily medication and 25% pn. After the revision we found in 85% of the patients unchanged condition, 4% was improved and in 11% a decrease in the status of the patient. In the latter group the drugs were reinstalled. Our economic estimation is that the revision saved 1200 SEK (»100 USD) in average per patient and year .
Conclusion: This study suggests that by optimizing the pharmacotherapy of the patients in nursing homes through drug revisions may be successful strategy. Unnecessary drugs can be stopped and the patient’s quality of life may be improved. At the same time this may decrease the cost for the community.
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