Appropriateness of use of medicines in elderly inpatients: qualitative study
- 10 August 2005
- Vol. 331 (7522), 935
- https://doi.org/10.1136/bmj.38551.410012.06
Abstract
Objectives To explore the processes leading to inappropriate use of medicines for elderly patients admitted for acute care. Design Qualitative study with semistructured interviews with doctors, nurses, and pharmacists; focus groups with inpatients; and observation on the ward by clinical pharmacists for one month. Setting Five acute wards for care of the elderly in Belgium. Participants 5 doctors, 4 nurses, and 3 pharmacists from five acute wards for the interviews; all professionals and patients on two acute wards for the observation and 17 patients (from the same two wards) for the focus groups. Results Several factors contributed to inappropriate prescribing, counselling, and transfer of information on medicines to primary care. Firstly, review of treatment was driven by acute considerations, the transfer of information on medicines from primary to secondary care was limited, and prescribing was often not tailored to elderly patients. Secondly, some doctors had a passive attitude towards learning: they thought it would take too long to find the information they needed about medicines and lacked self directed learning. Finally, a paternalistic doctor-patient relationship and difficulties in sharing decisions about treatment between prescribers led to inappropriate use of medicines. Several factors, such as the input of geriatricians and good communication between members of the multidisciplinary geriatric team, led to better use of medicines. Conclusions In this setting, improvements targeted at the abilities of individuals, better doctor-patient and doctor-doctor relationships, and systems for transferring information between care settings will increase the appropriate use of medicines in elderly people.Keywords
This publication has 20 references indexed in Scilit:
- Improving patients' safety locally: changing clinician behaviourThe Lancet, 2004
- Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderlyAmerican Journal Of Medicine, 2004
- Ask the patients--they may want to know more than you thinkBMJ, 2003
- A review and commentary of the social factors which influence stroke care: issues of inequality in qualitative literatureHealth & Social Care in the Community, 2003
- Effects of age on the quality of care provided to older patients with acute myocardial infarctionAmerican Journal Of Medicine, 2003
- Prescribing for SeniorsPublished by American Medical Association (AMA) ,1999
- General practitioners' perceptions of effective health careBMJ, 1999
- The physician–patient encounter: The physician as a perfect agent for the patient versus the informed treatment decision-making modelSocial Science & Medicine, 1998
- Elderly Patients and Their Medication: A Post-discharge Follow-up StudyAge and Ageing, 1992
- Reducing Polypharmacy in the ElderlyJournal of the American Geriatrics Society, 1990