{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T19:51:34Z","timestamp":1765828294867,"version":"3.41.2"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The aging population has increased concerns about the affordability, quality, and nature of long-term care for older people, emphasizing the role of nursing homes. Unlike acute hospital and primary care, there is a lack of drug consumption data in long-term care to understand regional or national healthcare policies.<\/jats:p><jats:p><jats:bold>Objectives:<\/jats:bold> This study aimed to describe medication consumption by older adults and expenditure in Italian nursing homes (NHs).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Data on drug consumption and costs from the administrative medicine informational flows that detect medicines packages supplied to patients in health facilities and NHs were used. Data on the characteristics of the healthcare residence were from the Italian Health Ministry. Records for the year 2019, selecting the nursing homes exclusively providing elderly or mixed (elderly and disabled) were used.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In 2019, the total expenditure on medicines in NHs amounted to 25.38 million euros, the average cost to 1.30 and the expenditure per bed to 436.18 euros. Cardiovascular drugs were the highest-consuming therapeutic class (177.0 defined daily doses\u2014DDDs\/100 days of NH stay; 22.2% of total) followed by drugs acting on the alimentary tract and metabolism (167.6% and 21.0%) and blood drugs (160.4% and 20.1%). The treatment of hypertension and heart failure was widely the most frequently used, with the consumption being driven mainly by furosemide and ramipril. Antiulcer drugs were used on average in more than half of the days of NH stay (58.5 DDDs\/100\u00a0days of NH stay), representing a therapeutic category for which deprescribing initiatives are recommended. On average, almost all patients received a dose of benzodiazepines, antipsychotics and antidepressants (37.6, 35.9, and 17.7 DDDs\/100\u00a0days of NH stay, respectively), confirming the high prevalence of use for these medicines. Antibiotics reached 6.8 DDDs\/100\u00a0days of NH stay.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The availability of data in this specific setting allows the identification of the main interventions toward improving appropriateness and represents a challenge for drug utilization research. Data from this study suggest that proton pump inhibitors (PPIs), benzodiazepines and antibacterials can be areas of improving prescribing appropriateness.<\/jats:p>","DOI":"10.3389\/fphar.2023.1128605","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T05:26:07Z","timestamp":1684301167000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Medication use in Italian nursing homes: preliminary results from the national monitoring system"],"prefix":"10.3389","volume":"14","author":[{"given":"S.","family":"Zito","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Poluzzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Pierantozzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Onder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Da Cas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Ippoliti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Lunghi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Cangini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Trotta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1111\/jgs.15767","article-title":"American Geriatrics society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults","volume":"67","year":"2019","journal-title":"J. Am. Geriatrics Soc."},{"key":"B2","doi-asserted-by":"publisher","first-page":"195","DOI":"10.7326\/0003-4819-123-3-199508010-00007","article-title":"Drug use in the nursing home","volume":"123","author":"Avorn","year":"1995","journal-title":"Ann. Intern. Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.jamda.2020.08.034","article-title":"Does psychotropic drug prescription change in nursing home patients the first 6 months after admission?","volume":"22","author":"Callegari","year":"2021","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"B4","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3390\/pharmacy8010039","article-title":"The cost of potentially inappropriate medications in nursing homes in West Occitanie","volume":"8","author":"Caucat","year":"2020","journal-title":"Pharm. (Basel, Switz."},{"key":"B5","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1177\/0269216310363649","article-title":"The impact of opioids, anticholinergic medications and disease progression on the prescription of laxatives in hospitalized palliative care patients: A retrospective analysis","volume":"24","author":"Clark","year":"2010","journal-title":"Palliat. Med."},{"key":"B40","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3389\/fdsfr.2022.1011701","article-title":"Deprescribing as a strategy for improving safety of medicines in older people: Clinical and regulatory perspective","volume":"2","author":"Crisafulli","year":"2022","journal-title":"Front. Drug Saf. Regul."},{"key":"B6","doi-asserted-by":"publisher","first-page":"3123","DOI":"10.1007\/s40520-022-02269-8","article-title":"Frailty, multimorbidity patterns and mortality in institutionalized older adults in Italy","volume":"34","author":"Damiano","year":"2022","journal-title":"Aging Clin. Exp. Res."},{"key":"B7","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s12877-019-1064-8","article-title":"Drug use differs by care level. A cross-sectional comparison between older people living at home or in a nursing home in Oslo, Norway","volume":"19","author":"Fog","year":"2019","journal-title":"BMC Geriatr."},{"key":"B8","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/S2155-8256(22)00033-3","article-title":"Conditions of nursing practice in hospitals and nursing homes before COVID-19: Implications for policy action","volume":"13","author":"French","year":"2022","journal-title":"J. Nurs. Regul."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1111\/j.1365-2648.2010.05297.x","article-title":"Laxative use in care homes","volume":"66","author":"Gage","year":"2010","journal-title":"J. Adv. Nurs."},{"key":"B10","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/S0140-6736(05)17907-0","article-title":"Outpatient antibiotic use in Europe and association with resistance: A cross-national database study","volume":"365","author":"Goossens","year":"2005","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1002\/pds.5383","article-title":"Trends in benzodiazepine and alternative hypnotic use in relation with multimorbidity among older adults in Quebec, Canada","volume":"31","author":"Gosselin","year":"2022","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"B12","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s12877-019-1054-x","article-title":"Constipation and laxative use among people living in nursing homes in 2007 and 2013","volume":"19","author":"Gustafsson","year":"2019","journal-title":"BMC Geriatr."},{"key":"B13","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1002\/pds.4142","article-title":"Trends in potentially inappropriate medication prescribing to nursing home patients: Comparison of three cross\u2010sectional studies","volume":"26","author":"Halvorsen","year":"2017","journal-title":"Pharmacoepidemiol. drug Saf."},{"key":"B14","unstructured":"Presidi residenziali socio-assistenziali (serie interrotte)"},{"key":"B15","unstructured":"The medicines utilization monitoring Centre (OsMed)2021"},{"volume-title":"\u00abESPN thematic report on challenges in long-term care - Italy - 2018\u00bb","year":"2018","author":"Jessoula","key":"B16"},{"key":"B17","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1093\/eurpub\/cky098","article-title":"Defining and measuring multimorbidity: A systematic review of systematic reviews","volume":"29","author":"Johnston","year":"2019","journal-title":"Eur. J. public health"},{"key":"B18","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1016\/j.jamda.2015.06.025","article-title":"Prevalence of frailty in nursing homes: A systematic review and meta-analysis","volume":"16","author":"Kojima","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"B19","doi-asserted-by":"publisher","first-page":"33","DOI":"10.3390\/idr13010006","article-title":"Incidence of antibiotic treatment failure in patients with nursing home-acquired pneumonia and community acquired pneumonia","volume":"13","author":"Lopes","year":"2021","journal-title":"Infect. Dis. Rep."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.2147\/NDT.S241780","article-title":"Prevalence and determinants of long-term utilization of antidepressant drugs: A retrospective cohort study","volume":"16","author":"Lunghi","year":"2020","journal-title":"Neuropsychiatric Dis. Treat."},{"key":"B41","doi-asserted-by":"publisher","first-page":"977","DOI":"10.3390\/ph15080977","article-title":"Strategies and tools for supporting the appropriateness of drug use in older people","volume":"15","author":"Lunghi","year":"2022","journal-title":"Pharmaceuticals (Basel)"},{"key":"B22","first-page":"500","article-title":"Management of constipation in older adults","volume":"92","author":"Mounsey","year":"2015","journal-title":"Am. Fam. physician"},{"volume-title":"NICE guidelines 2022: Depression in adults: Treatment and management","year":"2022","key":"B23"},{"key":"B24","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1093\/ageing\/afaa219","article-title":"Prevalence of frailty in 62 countries across the world: A systematic review and meta-analysis of population-level studies","volume":"50","author":"O'Caoimh","year":"2021","journal-title":"Age ageing"},{"key":"B25","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1007\/s40520-022-02094-z","article-title":"Italian guidelines on management of persons with multimorbidity and polypharmacy","volume":"34","author":"Onder","year":"2022","journal-title":"Aging Clin. Exp. Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"584","DOI":"10.7326\/0003-4819-120-7-199404010-00010","article-title":"Physician evaluation and management of nursing home residents","volume":"120","author":"Ouslander","year":"1994","journal-title":"Ann. Intern. Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1007\/s40266-015-0336-z","article-title":"A multicomponent intervention to optimize psychotropic drug prescription in elderly nursing home residents: An Italian multicenter, prospective, pilot study","volume":"33","author":"Pasina","year":"2016","journal-title":"Drugs and aging"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1007\/s00228-020-02871-7","article-title":"Drug prescriptions in nursing home residents: An Italian multicenter observational study","volume":"76","author":"Pasina","year":"","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1002\/pds.4963","article-title":"Overuse of proton pump inhibitors in nursing homes: An Italian multicenter observational study","volume":"29","author":"Pasina","year":"","journal-title":"Pharmacoepidemiol. drug Saf."},{"key":"B30","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1177\/0958928707071879","article-title":"Modelling an entitlement to long-term care services for older people in Europe: Projections for long-term care expenditure to 2050","volume":"17","author":"Pickard","year":"2007","journal-title":"J. Eur. Soc. policy"},{"key":"B31","doi-asserted-by":"publisher","first-page":"CD012572","DOI":"10.1002\/14651858.CD012572.pub2","article-title":"Withdrawal of antihypertensive drugs in older people","volume":"6","author":"Reeve","year":"2020","journal-title":"Cochrane database Syst. Rev."},{"key":"B43","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/ageing\/26.suppl_2.3","article-title":"Nursing homes in 10 nations: A comparison between countries and settings","volume":"26","author":"Ribbe","year":"1997","journal-title":"Age Ageing"},{"key":"B44","doi-asserted-by":"crossref","first-page":"747","DOI":"10.2165\/11538240-000000000-00000","article-title":"Potentially inappropriate drug prescriptions and risk of hospitalization among older, Italian, nursing home residents: the ULISSE project","volume":"27","author":"Ruggiero","year":"2010","journal-title":"Drugs Aging"},{"key":"B34","doi-asserted-by":"publisher","first-page":"126","DOI":"10.3390\/pharmacy7030126","article-title":"Polypharmacy definitions for multimorbid older adults need stronger foundations to guide research, clinical practice and public health","volume":"7","author":"Sirois","year":"2019","journal-title":"Pharm. (Basel, Switz."},{"key":"B35","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1007\/s41999-021-00477-5","article-title":"Interventions to optimize medication use in nursing homes: A narrative review","volume":"12","author":"Spinewine","year":"2021","journal-title":"Eur. Geriatr. Med."},{"volume-title":"National report on medicines use in older adults in Italy, 2021. Year 2019","year":"2021","key":"B36"},{"key":"B45","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.jamda.2013.04.005","article-title":"An international survey of nursing homes","volume":"14","author":"Tolson","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"B37","doi-asserted-by":"publisher","first-page":"23337214211050807","DOI":"10.1177\/23337214211050807","article-title":"Deprescribing statins and proton pump inhibitors in nursing home residents; a pragmatic exploratory study","volume":"7","author":"Visser","year":"2021","journal-title":"Gerontology geriatric Med."},{"volume-title":"Guidelines for ATC classification and DDD assignment","year":"2022","key":"B38"},{"volume-title":"The 2019 WHO AWaRe classification of antibiotics for evaluation and monitoring of use","year":"2019","key":"B39"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2023.1128605\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T05:26:24Z","timestamp":1684301184000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2023.1128605\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,17]]},"references-count":41,"alternative-id":["10.3389\/fphar.2023.1128605"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2023.1128605","relation":{},"ISSN":["1663-9812"],"issn-type":[{"type":"electronic","value":"1663-9812"}],"subject":[],"published":{"date-parts":[[2023,5,17]]},"article-number":"1128605"}}