Type 2 diabetes mellitus treatment patterns in U.S. nursing home residents.

BACKGROUND: The prevalence of type 2 diabetes mellitus (diabetes) in nursing home residents (NHRs) is increasing, concurrently with obesity and other comorbid conditions. NHR would benefit greatly from antidiabetic medications that would improve glycemic control and give a lower risk of hypoglycemia but that do not contribute to weight gain in obese individuals. OBJECTIVE: To examine the prescription patterns to NHRs with diabetes, including the use of newer injectable therapies such as glucagon-like peptide-1 (GLP-1) receptor agonists. METHODS: Treatment patterns of diabetes in NHR were analyzed using Minimum Data Set records and prescription claims from the Omnicare Senior Health Outcomes data repository (May 2011-September 2012). RESULTS: The prevalence of diabetes in this population of 229,283 NHRs was 35.4%. Among the 44,665 NHRs with diabetes and prescription claims data, the prevalence of obesity (40.3%) and multiple comorbidities (100%) was high. Approximately 20% of the NHRs with diabetes were aged <65 years. Overall, 20% of NHRs had diabetes that was untreated with medications during the study period. Insulin was the mainstay of treatment (>80%), followed by oral agents (54%). GLP-1 receptor agonist use was low (0.5%) and associated with poor treatment persistence. CONCLUSION: Considerations other than glycemic control may drive prescribing decisions, contrary to recommendations from the American Diabetes Association, American Medical Directors Association, and European Association for the Study of Diabetes.

Clinical and economic outcomes of a fall-focused pharmaceutical intervention program.

The effects of a fall-focused pharmaceutical intervention program (FFPIP) on the clinical and economic outcomes of elderly patients who fall while residing in a rehabilitation center are described. The objectives of this retrospective observational study were to identify the differences in the number of patient falls among elderly patients before and after pharmaceutical interventions, identify the cost savings related to decreasing the number of falls, and determine whether a relationship exists between falls among the elderly and specific medication classes. A data collection tool was developed by the investigators to record demographics and medication use. Two hundred patients were randomly selected from the preintervention (October 1, 1999-September 30, 2000) and postintervention (October 1, 2000-September 30, 2001) periods. Two data collectors collected data from patient medical records to test the data collection tool and ensure accuracy. The number of patient falls was reduced in the postintervention group by 47%, resulting in a future savings of $7.74 per patient per day. The use of several classes of medication also decreased in the postintervention period: cardiovascular agents, 10.7%; analgesics, 6.3%; psychoactive drugs, 18.2%; and sedatives and hypnotics, 13.9%. Patients most likely to fall were male, greater than 76 years of age, had a cardiovascular- or orthopedic-related diagnosis, and were taking analgesics, cardiovascular agents, and central nervous system agents, yet the intervention had a more significant effect on female patients. Implementation of an FFPIP decreased falls by 47% and decreased the use of cardiovascular drugs, analgesics, psychoactive medications, and sedatives and hypnotics.