Critical Literature Review Approaches to improving the quality of prescribing in nursing homes Essay

Critical Literature Review Approaches to improving the quality of prescribing in nursing homes
Abstract
The aging of the population has evoked a new care focus. The pro-portion of the world's population aged 60 years and over is predicted to reach one in five by 2050. [-1] Consequently prescribing for older people will escalate accordingly. Prescribing for older people is challenging due to complex medicine regimens and comorbidities. Evidence suggests that suboptimal prescribing still exists. Unnecessary and inappropriate drugs forming part of patient's drug therapy reinforces the need for improving prescribing quality. This review provides an insight into interventions undertaken by pharmacists alone and collaboratively with multi-healthcare professionals, in order to improve prescribing. The evidence base to support these was an indication as to the effectiveness of the approaches and is based on nursing home randomised controlled trials. Primary and secondary patient outcomes were measured post- intervention however the results were varied indicating difficulty in defining the success rate of the interventions. These included quality of life, medicine appropriateness and hospitalisation rates. Despite the success of some adopted approaches being effective for the intervention duration, the effects were not transferrable to long term patient outcomes. This review demonstrates the background literature surrounding poor quality prescribing and explores adopted interventions to target this issue. Intervention gaps in the literature are also emphasised. The contribution of all healthcare professionals and in particular pharmacists, was essential in obtaining diverse skills set to the benefit of the older population.
Background
The Aging Population and Long Term Care
Worldwide demographic change has resulted in an amplified elderly population. The United Nations predict a two fold increase to 22% by 2050 in the proportion of people aged 60 years and over. [1] Similarly it is estimated by 2034 a quarter of the UK population will be 65 years and over. [2] This
represents a transition phase in the provision of long term care to the elderly (termed 65 years or over) [3] in terms of increased demand. Improvements in health promotion, sanitation, infrastructure and education are accountable for this surge. [4] Globally, homes which deliver nursing care are defined differently. Care homes which deliver 24 hour nursing care are nursing
homes in the UK, skilled-nursing facilities in the US and aged-care facilities providing high-level care
in Australia. [5] A decrease in mortality rates and an increase in quality of life within the elderly population attributes for a greater proportion of older people living for longer. Consequently this population will require medicines therefore increasing prescriber pressure. Subsequently the quality of prescribing may be affected, interventions are approaches taken to prevent this. The review aim is to provide an insight into present suboptimal prescribing issues and an impartial evidence based overview of interventions, policies and approaches taken to improve prescribing quality within a nursing home setting. This review aims to provide an insight into prescribing quality that currently exists in long term care facilities, defining quality prescribing, the role of healthcare professionals in enhancing intervention success, and any literature deficiencies.