Quality of drug treatment in older people - Focus on hip fracture patients and multi-dose drug dispensing

Abstract

The aim of this thesis was to describe the quality of drug treatment (QDT) regarding fall-risk increasing (FRIDs) and fracture-preventing (FPDs) drugs in older hip fracture patients, to evaluate a method for improving such treatment, and to study the effects of multi-dose drug dispensing (MDD) on drug treatment changes and on QDT. A descriptive study of FRIDs and FPDs in a cohort of older hip fracture patients preceded a randomised controlled trial, in which the effects of an intervention regarding FRIDs and FPDs were investigated. A case-control study compared drug treatment changes of drugs prescribed via MDD or via ordinary prescriptions. In a register-based cross-sectional study QDT was compared in patients with or without MDD regarding five indicators of prescribing quality. In older hip fracture patients FRIDs were common, whereas FPDs were scarce. Medication reviews performed by a physician improved the treatment with FPDs after one year, but did not affect the treatment with FRIDs. The odds for a drug to remain unchanged after six months was greater for drugs prescribed via MDD. Potentially inappropriate drug treatment according to indicators for prescribing quality was more common for patients with MDD, also after adjustments for important covariates. QDT in older hip fracture patients may be improved regarding FPD, whereas extensive use of FRIDs is more difficult to affect. MDD is associated with poor QDT, i.e. fewer drug treatment changes and higher prevalence of potentially inappropriate drugs. These findings need to be further evaluated and taken into account when designing MDD systems.