Medication use in residential care facilities for the elderly.

OBJECTIVE: To describe medication use by residents of residential care facilities for the elderly (RCFEs). DESIGN: A cross-sectional survey of medication use. SETTING: Licensed, private RCFEs recruited from a roster of all licensed RCFEs in the Los Angeles area. SUBJECTS: Residents who were > or =60 years of age and whose medications were centrally stored in the facility. MEASURES: Age, gender, race, health insurance coverage, dietary restrictions, ambulation status, medical diagnoses, and medication profile. RESULTS: A total of 818 residents were surveyed. Residents were primarily white women who were >80 years. The average number of medications per resident was five; 94% of the sample took at least one medication. Cardiovascular drugs, central nervous system drugs, analgesics, diuretics, and potassium supplements were most commonly used. Use of multiple drugs within a therapeutic class was also common, with means ranging from 1.46 to 1.81 per resident for the most commonly prescribed classes. Diagnoses supporting the use of many medications were not documented in the residents' health records. CONCLUSIONS: This RCFE sample was medically frail and took many medications. The frequent use of cardiovascular medication reflected the prevalence of cardiac disease in the elderly. The frequency of psychotropic drug use without a corresponding indication suggested prescribing for symptoms rather than documented medical conditions. Lack of recorded diagnoses limited the ability to evaluate drug therapy. Improved record keeping; periodic medication review; and resident, staff, and prescriber education are necessary to ensure appropriate medication use in this setting.

Factors associated with antihypertensive prescribing.

OBJECTIVE: To investigate factors associated with treatment approaches to hypertension, a major risk factor for coronary heart and cerebrovascular disease and significant healthcare problem in the US. The study reports on three cross-sectional national surveys of patient-physician encounters. POPULATION: Visits were selected for adults with hypertension diagnoses from the National Ambulatory Medical Care Surveys, which represent office encounters during a given year. Years of observation included 1989, 1990, and 1991. METHODS: Multiple variable logistic regression was used to identify predisposing need, enabling, and health utilization characteristics associated with whether the visit resulted in a prescription of an antihypertensive. Additionally, the association of these visits with combination therapy is determined. RESULTS: For each of the 3 years, 69-75% of the encounters were associated with a prescription for drugs to treat hypertension. Prescribing is consistent with current literature demonstrating decreasing reliance on diuretics and beta-blockers, and increasing reliance on calcium antagonists. Combination therapy decreased as a percentage of prescriptions in 1990 and 1991. Variables associated with receiving an antihypertensive prescription included predisposing characteristics (patient age > 65 y), need characteristics (diagnosis of congestive hear failure [CHF]), and health utilization characteristics (physician specialty, previous diagnosis of hypertension). The most significant variables associated with combination therapy were predisposing characteristics (patient age > 65 y), need (CHF diagnosis, diagnosis of hypertension with end organ involvement), and health utilization characteristics (physician specialty). CONCLUSIONS: These national estimates reinforce previous regional data regarding the categories of hypertension medications used. Patient visits involving multiple diagnoses, cardiologists, or patients older than 65 years, are more likely to generate prescriptions for combination antihypertensive therapy.

The application of multiple quality-of-life instruments in individuals with mild-to-moderate psoriasis.

The 36-item Short-Form Health Survey Questionnaire (HSQ SF-36), Psoriasis Disability Index (PDI), and Dermatology Life Quality Index (DLQI) were administered to individuals with mild-to-moderate psoriasis to validate the general quality-of-life instrument against the dermatosis-specific, and the dermatology-specific, disability measure. The population consisted of 644 adults with psoriasis involving up to 20% of the body surface area, who were enrolled in 2 US multicentre, evaluator-blinded, parallel-group clinical trials for a new psoriasis medication. Patients averaged 16.5% of maximum possible disability as measured by the PDI, and 23.4% of maximum possible disability as measured by the DLQI. Normalised T-scores showed that the patients approximated US population means on all 8 of the HSQ SF-36 dimensions. The HSQ SF-36 scales did not reflect substantial quality-of-life impairment, although all showed statistically significant correlations with both the PDI and DLQI (correlation coefficients ranging from -0.13 to -0.45). Moreover, while the disability indices were more responsive to psoriasis characteristics than the HSQ SF-36 quality-of-life scales, all 8 HSQ SF-36 dimensions demonstrated sensitivity to at least some objective and/or subjective ratings of severity. The strongest relationships were observed between the PDI, DLQI and the HSQ SF-36 Mental Health and Social Functioning dimensions, suggesting that the HSQ SF-36 is sensitive to psychosocial suffering related to psoriasis, which is not conveyed in objective clinical measures of severity.