Appropriateness of use of medicines in elderly inpatients: qualitative study

doi:10.1136/bmj.38551.410012.06

BMJ 2005;331:935 (22 October), doi:10.1136/bmj.38551.410012.06 (published 10 August 2005)

Paper

Appropriateness of use of medicines in elderly inpatients: qualitative study

Anne Spinewine, research fellow¹, Christian Swine, professor in geriatrics and gerontology², Soraya Dhillon, head of pharmacy³, Bryony Dean Franklin, director⁴, Paul M Tulkens, professor of pharmacology and pharmacotherapy¹, Léon Wilmotte, chief pharmacist⁵, Vincent Lorant, sociologist⁶

¹ Centre for Clinical Pharmacy, School of Pharmacy, Université catholique de Louvain, 1200 Brussels, Belgium, ² Department of Geriatric Medicine, Mont-Godinne University Hospital, 5530 Yvoir, Belgium, ³ School of Pharmacy, University of Hertfordshire, Hatfield, Herts AL10 9AB, ⁴ Academic Pharmacy Unit, Hammersmith Hospitals NHS Trust, London W12 0HS, ⁵ Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, ⁶ School of Public Health, Université catholique de Louvain, Brussels

Correspondence to: A Spinewine anne.spinewine{at}facm.ucl.ac.be

Objectives To explore the processes leading to inappropriateuse of medicines for elderly patients admitted for acute care.

Design Qualitative study with semistructured interviews withdoctors, nurses, and pharmacists; focus groups with inpatients;and observation on the ward by clinical pharmacists for onemonth.

Setting Five acute wards for care of the elderly in Belgium.

Participants 5 doctors, 4 nurses, and 3 pharmacists from fiveacute wards for the interviews; all professionals and patientson two acute wards for the observation and 17 patients (fromthe same two wards) for the focus groups.

Results Several factors contributed to inappropriate prescribing,counselling, and transfer of information on medicines to primarycare. Firstly, review of treatment was driven by acute considerations,the transfer of information on medicines from primary to secondarycare was limited, and prescribing was often not tailored toelderly patients. Secondly, some doctors had a passive attitudetowards learning: they thought it would take too long to findthe information they needed about medicines and lacked selfdirected learning. Finally, a paternalistic doctor-patient relationshipand difficulties in sharing decisions about treatment betweenprescribers led to inappropriate use of medicines. Several factors,such as the input of geriatricians and good communication betweenmembers of the multidisciplinary geriatric team, led to betteruse of medicines.

Conclusions In this setting, improvements targeted at the abilitiesof individuals, better doctor-patient and doctor-doctor relationships,and systems for transferring information between care settingswill increase the appropriate use of medicines in elderly people.

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