Original StudyPotentially Inappropriate Prescribing of Primarily Renally Cleared Medications for Older Veterans Affairs Nursing Home Patients
Section snippets
Study Design, Setting, and Sample
This was a longitudinal study of 3480 patients admitted to any one of the 133 VA NHs (now called Community Living Centers) located in the United States between January 1, 2004, and June 30, 2005. A total of 1531 patients were included because they were 65 years of age or older at the time of admission, were long-stay patients (resided for ≥90 days), had at least 2 serum creatinine measurements within the previous 180 days, and received 1 of 21 primarily renally cleared medications (Appendix 1).
Results
Table 1 shows the characteristics of patients receiving one or more primarily renally cleared medications. Most patients were male and had multiple comorbidities. One in 5 patients were obese (BMI >30). Of these latter, only 22 of 271 had a BMI greater than 40. CKD was present in 26.22% of patients. The median estimated renal function using the Cockcroft-Gault and MDRD equations were 67 mL/min and 80 mL/min/1.73m2, respectively. When compared with the Cockcroft-Gault equation, the mean
Discussion
This study showed that more than 1 in 10 older long-stay patients in VA nursing homes had potentially inappropriate prescribing of primarily renally cleared medications when evidence-based, consensus-derived criteria were used. This is considerably less than the 42% rate of prescribing problems found in 456 patients prescribed 1 of 20 primarily renally cleared drugs reported in the study by Papaioannou et al9 in 4 long-term care facilities in 3 Canadian cities. It is also less than the 46% of
Acknowledgments
We acknowledge the support and access to MDS data provided by Christa M. Hojlo, PhD, RN, NHA, Director VA Nursing Home Care, VA Central Office, and Nick Castle, PhD, from the Graduate School of Public Health, University of Pittsburgh, for his earlier help with MDS data.
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There was no funding for the current study. S.M.H. was supported by a National Institutes of Health Roadmap Multidisciplinary Clinical Research Career Development Award grant (K12 RR023267). J.T.H. was supported by the following: National Institute of Aging grants (R01AG027017, P30AG024827, T32 AG021885, K07AG033174, R01AG034056), a National Institute of Mental Health grant (R34 MH082682), a National Institute of Nursing Research grant (R01 NR010135), an Agency for Healthcare Research and Quality grant (R01 HS017695), and a VA Health Services Research grant (IIR-06–062).