Pharmacologic treatment of diabetes in long-term care.

The majority of patients with diabetes are elderly, but little is known about their disease management. This study evaluates the prevalence and correlates of treatment of elderly diabetics residing in long-term care. We performed a retrospective, cross-sectional study of 75,829 elderly diabetics residing in nursing homes from 1992 to 1996. Nearly half (47%) of the residents received no antidiabetic medications. Independent predictors not receiving antidiabetic medications included age, race, impaired physical ability, and impaired cognitive function. Although the absence of resident's blood glucose or glycosylated hemoglobin (HbA1c) values prevents us from passing judgment about the adequacy of diabetic care, further research is needed to understand why some residents do not receive antidiabetic medications in the long-term care setting.

Effect of nonsteroidal anti-inflammatory drug use on the rate of gastrointestinal hospitalizations among people living in long-term care.

OBJECTIVES: Gastrointestinal (GI) complications are the most-common serious adverse reactions associated with nonsteroidal anti-inflammatory drugs (NSAIDs). We quantified the effect of specific NSAIDs on the rate of GI hospitalizations among older people living in long-term care. DESIGN: Retrospective cohort study. SETTING: All Medicare/Medicaid certified nursing homes in four states (Maine, Minnesota, New York, and South Dakota). PARTICIPANTS: We identified 125,516 newly admitted residents from a database of all residents (1992-1996) of all Medicare/Medicaid certified nursing homes in four states. Using the federally mandated Minimum Data Set, which includes information on all drugs received (prescription and over-the-counter), we identified patients who received at least one prescription for aspirin (n = 19,101) or NSAIDs (n = 9,777). The control population consisted of all institutionalized persons who did not receive these drugs. MEASUREMENTS: From Health Care Financing Administration inpatient claims, we identified the first hospitalization for GI perforation, ulcer, or hemorrhage that occurred during the year of follow up (ICD9-CM discharge codes: 531-534, 578). Cox proportional hazards models provided adjusted estimates of rate ratios. RESULTS: NSAID exposure increased the GI-event-related hospitalization rate in both men (rate ratios (RR) = 2.64; 95% confidence interval (CI) = 1.17-5.99) and women (RR = 3.23; 95% CI = 1.85-5.65). The rate of GI hospitalizations for both men and women taking sulindac, naproxen, or indomethacin was higher than for nonusers. The risk of GI-event-related hospitalizations was greatest among women exposed to diflunisal (RR = 6.08; 95% CI = 2.27-16.26) or oxaprozin (RR = 6.03; 95% CI = 2.49-14.58). CONCLUSIONS: Despite the high background rate of GI events, most NSAIDs increased the risk of GI hospitalization. Careful attention to choice of agent and dosing is needed in prescribing NSAIDs in this frail, older population.

The effect of nonsteroidal anti-inflammatory drugs on the use of gastroprotective medication in people with arthritis.

OBJECTIVE: To estimate the incidence of gastroprotective medication use among users and nonusers of prescription nonsteroidal anti-inflammatory drugs (NSAIDs) who have arthritis. STUDY DESIGN: A retrospective cohort study. PATIENTS AND METHODS: We used the Protocare Sciences proprietary Managed Care Organization database, which contains data on more than 3 million lives, to identify 57,136 patients given an initial diagnosis of osteoarthritis (OA; International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] codes: 715, 721.0, 721.3, or 721.9) or rheumatoid arthritis (RA; ICD-9-CM codes: 714.0, 714.1, 714.2, or 714.9); the diagnoses were made during inpatient or outpatient medical encounters occurring between October 1, 1993, and September 30, 1997. The duration of therapy was calculated as the sum of the total number of days of receipt of all prescriptions during the year. The prescribed daily dose was determined by multiplying the drug dose by the number of pills dispensed and the dividing the product by the number of days supplied, as noted in the pharmacy records. RESULTS: During the year after NSAID initiation, 27% of people with RA and 12% of those with OA were chronic NSAID users. NSAID users with RA were 4 times as likely as NSAID nonusers with RA to begin using a gastroprotective agent within the first year; NSAID users with OA were twice as likely as nonusers with OA to do so. CONCLUSION: The use of gastroprotective agents during the first year after NSAID initiation for the treatment of arthritis was greater than their use by those who did not take NSAIDs.