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Long-Term Care in the News
Geriatric Times May/June 2001 Vol. II Issue 3
Survey Examines Medication Usage in Nursing FacilitiesThe 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 InfectionsAt 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 CareFollowing 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
