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• W2000566189 abstract "The existence of specialty prescribers is challenging. 1 Levenson S.A. Saffel D.A. The consultant pharmacist and the physician in the nursing home: Roles, relationships, and a recipe for success. J Am Med Dir Assoc. 2007; 8: 55-64 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Multiple prescribers have been identified as a risk factor for treatment with medications considered to be “inappropriate.” 2 Dhalla I.A. Anderson G.M. Mamdani M.M. Bronskill S.E. Sykora K. Rochon P.A. Inappropriate prescribing before and after nursing home admission. J Am Geriatr Soc. 2002; 50: 995-1000 Crossref PubMed Scopus (85) Google Scholar The use of “inappropriate” medications, in turn, has been associated with adverse outcomes such as hospitalization and death. 3 Lau D.T. Kasper J.D. Potter D.E. Lyles A. Bennett R.G. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med. 2005; 165: 68-74 Crossref PubMed Scopus (341) Google Scholar In my experience, specialty prescribed medications include muscle relaxants for spasticity induced by upper motor neuron lesions (tizanidine, baclofen, and dantrolene), antiseizure medications (phenobarbital, carbamazepine, phenytoin), and the anti-arrhythmic (amiodarone). 4 Veterans Health AdministrationDepartment of DefenseVA/DoD clinical practice guideline for the management of stroke rehabilitation in the primary care setting. in: Department of Veterans Affairs, Washington, DC2003: 1-44http://www.oqp.med.va.gov/cpg/STR/STR_base.htm Google Scholar , 5 American College of Cardiology/American Heart Association Task ForceEuropean Society of Cardiology Committee for Practice GuidelinesACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. J Am Coll Cardiol. 2006; 48: 1064-1108 Abstract Full Text Full Text PDF Scopus (149) Google Scholar Other examples include immunomodulating agents for rheumatoid arthritis and psychiatric medications. Primary physicians may be uncomfortable determining if these “specialty” medications are indicated or the lowest effective dose. Unfortunately, office-based specialty consultants may not be aware of the “big picture.” 6 Levenson S.A. Morley J.E. Evidence rocks in long-term care, but does it roll?. J Am Med Dir Assoc. 2007; 8: 493-501 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar The urology consultant may focus on a single problem such as urge incontinence and give little attention to systemic anticholinergic effects. 7 Monane M. Avorn J. Beers M.H. Everitt D.E. Anticholinergic drug use and bowel function in nursing home patients. Arch Intern Med. 1993; 153: 633-638 Crossref PubMed Google Scholar , 8 Tune L.E. Serum anticholinergic activity levels and delirium in the elderly. Semin Clin Neuropsychiatry. 2000; 5: 149-153 PubMed Google Scholar The neurology consultant may advance the dose of medications for Parkinson’s disease in an effort to maintain ambulation without awareness of hallucinations and agitation triggered by the medications. 9 Olanow C.W. Watts R.L. Koller W.C. An algorithm (decision tree) for the management of Parkinson’s disease (2001): Treatment guidelines. Neurology. 2001; 56: S1-S88 Crossref PubMed Google Scholar" @default.
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• W2000566189 title "Medications Prescribed by Specialists in Nursing Homes" @default.
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• W2000566189 doi "https://doi.org/10.1016/j.jamda.2007.11.004" @default.
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