Drug utilization in Belgian nursing homes: impact of residents' and institutional characteristics

Purpose This study aims to investigate drug utilization in Belgian nursing homes in relation to the characteristics of residents and the institution. Methods A cross-sectional study design was used. A total of 2510 residents were randomly selected from a stratified random sample of 76 Belgian nursing homes with at least 30 beds, including high-intensity care beds. Data collection was based on medical chart review supplemented with clinical information from general practitioners (GPs) Results The residents included had a mean age of 85 and 77% were female. They presented a median of 2 clinical problems (range 0-10), three care problems (range 0-10) and 48% had dementia. Their medical consumption amounted to a mean of 8.4 prescriptions including 7.1 for chronic treatment. Mean expenditure per month for chronic medication was 140 EUR (SD 125), including 53 EUR out-of-pocket payment. This study confirmed that multiple comorbidity was associated with polypharmacy. After peaking in the seventh decade, medical consumption decreased in older age groups. In palliative care, the number of prescriptions decreased while expenditure increased. A marked decrease in prescriptions, particularly of pain-relieving medication, was observed with increasing dementia. Larger public institutions, with an active coordinating physician and served by hospital pharmacists, had lower consumption and expenditure. Conclusion A high level of drug utilization, influenced by the characteristics of residents and the institution, was observed in Belgian nursing homes. There is a need to develop a comprehensive monitoring system of prescribing quality for nursing home residents. Copyright (C) 2010 John Wiley & Sons, Ltd.