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Medicine and Public Policy |

Inappropriate Medication Prescribing in Skilled-Nursing Facilities

Mark H. Beers, MD; Joseph G. Ouslander, MD; Susan F. Fingold, BS; Hal Morgenstern, PhD; David B. Reuben, MD; William Rogers, PhD; Mira J. Zeffren, PharmD; and John C. Beck, MD
[+] Article and Author Information

Grant Support: In part by the John A. Hartford Foundation and by the University of California, Los Angeles, Geriatric Academic Program Award from the National Institutes of Health (Dr. Beers).

Requests for Reprints: Mark H. Beers, MD, Merck & Co., Inc., BLA-22, POB4, West Point, PA 19486-0004.

Current Author Addresses: Dr. Beers: Merck & Co., Inc., BLA-22, POB4, West Point, PA 19486-0004.

Drs. Ouslander, Reuben, and Beck, and Ms. Fingold: University of California, Los Angeles, Multicampus Division of Geriatrics and Gerontology, Center for Health Sciences, School of Medicine, Factor A-671, Los Angeles, CA 90024-1687.

Dr. Morgenstern: University of California, Los Angeles, School of Public Health, Department of Epidemiology, Los Angeles, CA 90024-1772.

Dr. Rogers: The Rand Corporation, 1800 Main Street, Santa Monica, CA 90403.

Dr. Zeffren: Patient Care Pharmacy, 6300 Arizona Circle, Los Angeles, CA 90045.


© 1992 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1992;117(8):684-689. doi:10.7326/0003-4819-117-8-684
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Objective: To quantify the appropriateness of medication prescriptions in nursing home residents.

Design: Prospective, cohort study.

▪ Setting: Twelve nursing homes in the greater Los Angeles area.

Participants: A total of 1106 nursing home residents.

Main Outcome Measures: The appropriateness of medication prescriptions was evaluated using explicit criteria developed through consensus by 13 experts from the United States and Canada. These experts identified 19 drugs that should generally be avoided and 11 doses, frequencies, or durations of use of specific drugs that generally should not be exceeded.

Results: Based on the consensus criteria, 40% of residents received at least one inappropriate medication order, and 10% received two or more inappropriate medication orders concurrently; 7% of all prescriptions were inappropriate. Physicians prescribed a greater number of inappropriate medications for female residents. Regression analysis, corrected for clustering effects within facilities, showed that a greater number of inappropriate medication prescriptions were ordered in larger nursing homes. Inappropriate prescriptions were not related to the proportion of Medicaid (Medical) residents or the number of physicians practicing in the homes.

Conclusions: Inappropriate medication prescribing in nursing homes is common. Female residents and residents of large nursing homes are at the greatest risk for receiving an inappropriate prescription.

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