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June 26, 2008Improving the Use of Medicines for Older People in Long-Term Care: Contrasting the Policy Approach of Four Countries |
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From The Commonwealth Fund: Compared with Australia, New Zealand, and the United Kingdom, U.S. nursing homes have been more successful in preventing or reducing the unnecessary use of psychotropic medications, but less so in promoting best practices of overall appropriate medication use, finds a Commonwealth Fund-supported review of nursing home medication policies in four nations. Of the four countries, the United States has "led the way in implementing intense regulation and oversight of care provisions in nursing homes," concluded a multinational research team led by Carmel M. Hughes, Ph.D., a former Commonwealth Fund Harkness Fellow based at Queen's University in Belfast. The focus on preventing or reducing poor practices has not encouraged appropriate drug use, for example, in heart failure or Parkinson's disease, or in other conditions known to be undertreated in nursing homes. U.S.: The regulatory system, implemented to reduce unnecessary psychotropic medication, may issue sanctions for facilities not meeting regulations and other indices of care. Australia: Australia established an "ambitious and comprehensive framework" for improving use of medicines across the whole community. Medication reviews and guidelines for medication management in nursing homes have been incorporated into accreditation standards. Because of a lack of data, measurement has not been possible. While national minimum standards regarding medication have been adopted, these are seen as a code of practice lacking statutory force. New Zealand: Medication policy has been focused on rationalizing drug expenditures. Nursing home standards, including pharmaceutical review for long-term care residents, were released by the health ministry, but funding and other issues have made such reviews sporadic. While certain antipsychotic and other drugs are restricted to specialist prescribing, use of psychotropic drugs has been high historically.
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