Potentially Harmful Medication Prescribing by the Degree of Physician Specialization in Nursing Home Practice: An Observational Study.
Kira Ryskina, Derrick Lo, Tingting Zhang and 3 others
PMID 37088104WHAT IT FOUND
Nursing home specialists did not prescribe fewer potentially harmful medications overall, but their patients used them for shorter periods.
However, specialists prescribed more benzodiazepines, and advanced practitioners were more likely to be high prescribers than physicians.
Key findings
01The likelihood of receiving any potentially harmful medication was not significantly different between residents cared for by nursing home specialists and those cared for by non-specialists.
02Among residents who did receive potentially harmful medications, those cared for by nursing home specialists were less likely to have prolonged use (over 75% of days) compared to those cared for by non-specialists.
03Nursing home specialists prescribed benzodiazepines at a higher rate than non-specialists, although the duration of use for this class was still shorter.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The observational design cannot prove that nursing home specialization caused the differences in medication duration. The study only included Medicare fee-for-service beneficiaries, so results may not apply to residents with Medicare Advantage or commercial insurance. The definition of 'NH-specialist' relied on billing codes (more than 90% of visits in nursing homes), which may not fully capture clinical expertise or experience. Medications started in hospitals or during short stays were not captured in the Part D claims data.
Declared interests
The authors declared no relevant conflicts of interest. The study was supported by the National Institute on Aging (N.I.H., Extramural).
The easy way to misread this
Do not conclude that nursing home specialists reduce the overall volume of potentially harmful medications. The rate of any use was identical between groups; the benefit was limited to shorter duration of exposure, and benzodiazepine prescribing was actually higher in the specialist group.