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Inappropriate use of medicines in acute care for the elderly related to a focus on acute care, providers’ passive attitudes about learning, and paternalistic decision making

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 Q What are the perspectives of healthcare providers and patients on the appropriateness of medication use in elderly patients on acute care hospital wards?

DESIGN

Qualitative study.

SETTING

Acute care wards for the elderly in 5 hospitals in Belgium.

PARTICIPANTS

A purposive sample of 17 patients who were stable, had no cognitive impairment, had ⩾1 modification in chronic medication, and managed their own medication at home; 5 physicians and 4 nurses working on the wards; and 3 hospital pharmacists.

METHODS

Data were collected using individual semistructured interviews (doctors, nurses, pharmacists, and 5 patients), focus groups (12 patients), and observation of the main activities on 2 wards (by 2 pharmacists). Interviews and focus groups were taped and transcribed verbatim. Observations of events relating to medicine use were recorded in notes, which were written up in detail using an observation grid. Data were analysed using grounded theory principles from both biomedical and sociological perspectives.

MAIN FINDINGS

Most providers felt that prescribing was sometimes inappropriate and that patient counselling was insufficient. 3 categories underpinned the inappropriate use of medicines. (1) Reliance on general acute care and short term treatment. Most providers thought that they …

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