Full-Time Nursing Home Doctors Less Likely to Medicate

Physicians employed full-time at a nursing home reduced prescriptions significantly, while community physicians tended to do the opposite, a new study finds. The information provided by the study, and more, the insights the study suggests regarding managing pharmaceutical care are invaluable in making decisions regarding institutional care and between competing institutional care alternatives.

According to an article in McKnight's Long-term Care News, researchers followed long-term stay residents for 12 months, with a goal of learning whether prescriptions were reduced after their first year at the facility, in an.effort to develop effective models for post-acute care for seniors. Results appeared last month in The Senior Care Pharmacist and were publicized last week by BRI. 

One of the reasons medication prescription, use, and management are of importance in evaluating alternatives is that so often medication mistakes or mismanagement lead to adverse health outcomes.  In fact, medications are a large part of the reason that persons discharged to nursing homes from hospitals are forced back to the hospital for additional care, or "readmissions," as they are identified by Medicare.  “Readmissions rates are a huge stressor, with 30% of readmissions due to medication issues,”  said LAJH Chief Medical Officer and Brandman Executive Director Noah Marco, M.D., as reported by  McKnight’s. “We said, ‘Let’s focus on medications first.’ Our hypothesis was that people will be coming in on a large number of medications and at the end of the year, their medications will be reduced.” 

But the mean number of scheduled prescriptions increased from 11.1 prior to admission to 13.3 by the end of the year, they found. Marco and team were shocked. When he and researchers dug into the data, they found that physicians employed full-time by the home ordered significantly fewer additional prescriptions. The home has five full-time geriatricians, with about the same number of community physicians also treating residents.

While more research is needed, Marco suspects that the on-staff geriatricians have a different philosophy with regards to medication.  Physicians employed full-time by the home get to know the patients, and the nursing staff.  "With that knowledge and alignment, we can create a plan,” he said.  The challenge is to find more avenues to study this patient population, he said. Marco also noted that pharmacists play a critical role in long-term care facilities.

“Just as they are playing a more important role in quality of care in the hospital, it’s incredibly important for more work to demonstrate the value of pharmacists actively involved in the day-to-day future care of this population,” he said. “I’m thankful I have such skilled pharmacists who are actively helping us create knowledge.”