1: BMJ. 2005 Oct 22;331(7522):935. Epub 2005 Aug 10. 

Appropriateness of use of medicines in elderly inpatients: qualitative study.

Spinewine A, Swine C, Dhillon S, Franklin BD, Tulkens PM, Wilmotte L, Lorant V.

Centre for Clinical Pharmacy, School of Pharmacy, Universite catholique de
Louvain, 1200 Brussels, Belgium. anne.spinewine@facm.ucl.ac.be

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.

PMID: 16093254 [PubMed - in process]