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Gisladottir S, Sigurdardottir AK, Hjaltadottir I. Use of psychiatric medication in three Arctic nursing homes: association with dementia and psychiatric symptoms. Int J Circumpolar Health 2021; 80:1920252. [PMID: 33899700 PMCID: PMC8079027 DOI: 10.1080/22423982.2021.1920252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2022] Open
Abstract
As more people reaches advanced age, more people experience cognitive impairment and dementia. Dementia is a degenerative disease in which behavioural and psychological symptoms frequently occur, resulting in admissions to nursing homes (NHs), where the most common treatment has been medical treatment. The aim was to compare three rural Arctic NHs in Iceland in their use of psychiatric medication, type of dementia among residents, level of cognitive impairment and selected quality indicators, as well as considering national data, for the period 2016-2018. Data from the interRAI-MDS 2.0 evaluation were used. Residents with severe cognitive impairment used more antipsychotic medications, and residents with mild and severe cognitive impairment used more antidepressants than residents with no cognitive impairment did. Diagnoses of Alzheimer's Disease and Related Dementias (ADRD) are more common in the capital area and the national average than they are in the rural NHs. This indicates need for diagnostic assessments of ADRD to be conducted in rural areas. Benchmarking is beneficial for local and national regulatory bodies to find areas for improvement. The NHs did not have a lower quality of care compared with the whole country, but areas for improvement were identified. One of the NHs has already started this process.
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Affiliation(s)
- Sigurveig Gisladottir
- Fossahlid Nursing Home, Health Care Institution of Eastern Iceland
- University of Akureyri, School of Health Sciences, Akureyri, Iceland
| | - Arun K. Sigurdardottir
- University of Akureyri, School of Health Sciences, Akureyri, Iceland
- Akureyri Hospital, Akureyri, Iceland
| | - Ingibjörg Hjaltadottir
- Faculty of Nursing, University of Iceland
- Division of Clinical Services Landspítali, National University Hospital, Reykjavik, Iceland
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Kelleher JE, Weedle P, Donovan MD. The Prevalence of and Documented Indications for Antipsychotic Prescribing in Irish Nursing Homes. PHARMACY 2021; 9:pharmacy9040160. [PMID: 34698248 PMCID: PMC8544697 DOI: 10.3390/pharmacy9040160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Setting: This study was conducted in six nursing homes located in Co. Cork, Ireland. Method: A retrospective, cross-sectional study was employed. All patients who met the inclusion criteria (≥65 years, residing in a nursing home on a long-term basis) were eligible for inclusion. There were 120 nursing home residents recruited to the study. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Results: The overall prevalence of antipsychotic prescribing was found to be 48% and patients with dementia were significantly more likely to be prescribed an antipsychotic compared to those without dementia (67% vs. 25%) (χ2 (1, N = 120) = 21.541, p < 0.001). In the cohort of patients with dementia, there was a trend approaching significance (p = 0.052) of decreasing antipsychotic use with increasing age (age 65–74 = 90%; age 75–84 = 71%; age 85 and over = 58%). An indication was documented for 84% of the antipsychotic prescriptions in this cohort. Conclusions: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings.
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Affiliation(s)
- Jayne E. Kelleher
- Peter Weedle Allcare Pharmacy, P51HCP4 Cork, Ireland; (J.E.K.); (P.W.)
| | - Peter Weedle
- Peter Weedle Allcare Pharmacy, P51HCP4 Cork, Ireland; (J.E.K.); (P.W.)
| | - Maria D. Donovan
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12YN60 Cork, Ireland
- Correspondence:
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A Canadian Cohort Study to Evaluate the Outcomes Associated with a Multicenter Initiative to Reduce Antipsychotic Use in Long-Term Care Homes. J Am Med Dir Assoc 2020; 21:817-822. [PMID: 32493650 DOI: 10.1016/j.jamda.2020.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the impact of a multicenter intervention to reduce potentially inappropriate antipsychotic use in Canadian nursing homes at the individual and facility levels. DESIGN Longitudinal, population-based cohort study to evaluate the Canadian Foundation for Healthcare Improvement's Spreading Healthcare Innovations Initiative to reduce potentially inappropriate antipsychotic use in 6 provinces/territories. SETTING AND PARTICIPANTS Adults in nursing homes in 6 provinces/territories in Canada between 2014 and 2016. The sample involved 4927 residents in 45 intervention homes and 122,570 residents in 1193 control homes in the first quarter of the study. MEASURES Assessment data based on the Resident Assessment Instrument 2.0 were used in both settings to track antipsychotic use and to obtain risk-adjusters for a quality indicator on potentially inappropriate use. INTERVENTION Quality improvement teams in participating organizations were provided with education, training, and support to implement localized strategies intended to reduce antipsychotic medication use in residents without diagnosis of psychosis. RESULTS At the resident level, we found that the odds of remaining on potentially inappropriate antipsychotics were 0.75 in intervention compared with control homes after adjusting for age, sex, aggressive behavior, and cognition. These findings were evident within the pooled Canadian data as well as within provinces. At the facility level, the intervention homes had greater improvements in risk-adjusted quality indicator performance than the control homes, and this was true for the worst, median, and best-performing homes at baseline. There was no major change in the quality indicator for worsening of behavior symptoms. CONCLUSIONS/IMPLICATIONS The Canadian Foundation for Healthcare Improvement intervention was associated with a reduction in potentially inappropriate antipsychotic use at both the individual and facility levels of analysis. This improvement in performance was independent of secular trends toward reduced antipsychotic use in participating provinces. This suggests that substantial improvements in medication use may be achieved through targeted, collaborative quality improvement initiatives in long-term care.
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Kok JS, Oude Voshaar RC, Scherder EJA. Psychotropic drug use in residents with dementia living in small-scaled special care facilities; a longitudinal study. Aging Ment Health 2020; 24:689-696. [PMID: 30835505 DOI: 10.1080/13607863.2019.1584784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Over the past decade, a trend has been noticed in the Netherlands to replace large-scaled special care units (SCUs) caring for 20-30 residents with dementia by small-scaled SCUs caring for up to 8 residents. Systematic evaluations, however, have yielded a differentiated picture of the effects. As the impact on psychotropic drug use has hardly been addressed thus far, we examined the (potential) impact of psychotropic drug use when moving residents with dementia from large-scaled to small-scaled SCUs.Methods: We conducted a non-randomized, controlled study with a six-month follow-up. Among 145 residents with dementia living a large-scaled SCUs for dementia caring for 20-30 residents per unit, a total of 77 residents were moved to small-scaled SCUs caring for up to 8 residents per unit. Psychotropic drug use, classified according to the Anatomical Therapeutic Chemical Classification (ATC) system was monitored at 2 months before replacement, as well as at 3 and 6 months thereafter. Repeated measures ANOVAs were conducted for the mean Defined Daily Doses (DDDs) of both groups.Results: No significant differences between both groups in psychotropic medication use were found over a period of 8 months.Conclusion: Prescription of psychotropic drugs does not change after a transfer from a large-scaled SCU to a small-scaled SCU of patients with moderate to severe dementia.Current Controlled Trials: ISRCTN11151241.
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Affiliation(s)
- Jeroen S Kok
- Lentis
- Dignis, Mental Health Care Institute, Zuidlaren, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
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Smeets CHW, Gerritsen DL, Zuidema SU, Teerenstra S, van der Spek K, Smalbrugge M, Koopmans RTCM. Psychotropic drug prescription for nursing home residents with dementia: prevalence and associations with non-resident-related factors. Aging Ment Health 2018; 22:1239-1246. [PMID: 28726490 DOI: 10.1080/13607863.2017.1348469] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine psychotropic drug prescription rates in nursing home residents with dementia and to identify associations with the so far understudied psychosocial non-resident-related factors. METHOD A cross-sectional, observational, exploratory design as part of PROPER I (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia). Participants were 559 nursing home residents with dementia, 25 physicians, and 112 nurses in the Netherlands. Psychotropic drug prescription, non-resident-related and known resident-related variables were measured to operationalize the themes of our previous qualitative analysis. RESULTS Fifty-six percent of residents were prescribed any psychotropic drug, 25% antipsychotics, 29% antidepressants, 15% anxiolytics, and 13% hypnotics, with large differences between the units. Multivariate multilevel regression analyses revealed that antipsychotic prescription was less likely with higher physicians' availability (odds ratio 0.96, 95% confidence interval 0.93-1.00) and that antidepressant prescription was more likely with higher satisfaction of nurses on resident contact (odds ratio 1.50, 95% confidence interval 1.00-2.25). Resident-related factors explained 6%-15% of the variance, resident- and non-resident-related factors together 8%-17%. CONCLUSION Prescription rates for antipsychotics are similar compared to other countries, and relatively low for antidepressants, anxiolytics, and hypnotics. Our findings indicate that improvement of prescribing could provisionally best be targeted at resident-related factors.
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Affiliation(s)
- Claudia H W Smeets
- a Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health , Radboud university medical center , Nijmegen , The Netherlands.,b Alzheimer Center , Radboud university medical center , Nijmegen , The Netherlands
| | - Debby L Gerritsen
- a Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health , Radboud university medical center , Nijmegen , The Netherlands.,b Alzheimer Center , Radboud university medical center , Nijmegen , The Netherlands
| | - Sytse U Zuidema
- c Department of General Practice, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands
| | - Steven Teerenstra
- d Section Biostatistics, Department of Health Evidence, Radboud Institute for Health Sciences , Radboud university medical center , Nijmegen , The Netherlands
| | - Klaas van der Spek
- a Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health , Radboud university medical center , Nijmegen , The Netherlands.,b Alzheimer Center , Radboud university medical center , Nijmegen , The Netherlands
| | - Martin Smalbrugge
- e Department of General Practice and Elderly Care Medicine/ EMGO+ Institute for Health and Care Research , VU Medical Center , Amsterdam , The Netherlands
| | - Raymond T C M Koopmans
- a Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health , Radboud university medical center , Nijmegen , The Netherlands.,b Alzheimer Center , Radboud university medical center , Nijmegen , The Netherlands.,f Joachim en Anna, Center for Specialized Geriatric Care , Nijmegen , The Netherlands
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Joyce NR, McGuire TG, Bartels SJ, Mitchell SL, Grabowski DC. The Impact of Dementia Special Care Units on Quality of Care: An Instrumental Variables Analysis. Health Serv Res 2018; 53:3657-3679. [PMID: 29736944 DOI: 10.1111/1475-6773.12867] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To compare the quality of care following admission to a nursing home (NH) with and without a dementia special care unit (SCU) for residents with dementia. DATA SOURCES/STUDY SETTING National resident-level minimum dataset assessments (MDS) 2005-2010 merged with Medicare claims and provider-level data from the Online Survey, Certification, and Reporting database. STUDY DESIGN We employ an instrumental variable approach to address the endogeneity of selection into an SCU facility controlling for a range of individual-level covariates. We use "differential distance" to a nursing home with and without an SCU as our instrument. DATA COLLECTION/EXTRACTION METHODS Minimum dataset assessments performed at NH admission and every quarter thereafter. PRINCIPAL FINDINGS Admission to a facility with an SCU led to a reduction in inappropriate antipsychotics (-9.7 percent), physical restraints (-9.6 percent), pressure ulcers (-3.3 percent), feeding tubes (-8.3 percent), and hospitalizations (-14.7 percent). We found no impact on the use of indwelling urinary catheters. Results held in sensitivity analyses that accounted for the share of SCU beds and the facilities' overall quality. CONCLUSIONS Facilities with an SCU provide better quality of care as measured by several validated quality indicators. Given the aging population, policies to promote the expansion and use of dementia SCUs may be warranted.
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Affiliation(s)
- Nina R Joyce
- Department of Health Services Policy and Practice, Brown School of Public Health, Brown University School of Public Health, Providence, RI.,Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Thomas G McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Stephen J Bartels
- Department of Psychiatry, Community and Family Medicine, The Dartmouth Institute, Hanover, NH.,Dartmouth Centers for Health and Aging, Geisel School of Medicine at Dartmouth, Hanover, NH.,New Hampshire-Dartmouth Psychiatric Research Center, Hanover, NH
| | - Susan L Mitchell
- Hebrew Senior Life Institute for Aging Research, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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Castberg I, Westin AA, Skogvoll E, Spigset O. Effects of age and gender on the serum levels of clozapine, olanzapine, risperidone, and quetiapine. Acta Psychiatr Scand 2017; 136:455-464. [PMID: 28865402 DOI: 10.1111/acps.12794] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate serum concentrations of second-generation antipsychotics in relation to age and gender in a population ranging from 18 to 100 years. METHOD Results from a routine therapeutic drug monitoring database were retrieved, and 43 079 samples from 11 968 patients were included (17 249 samples for clozapine, 16 171 samples for olanzapine, 5343 samples for risperidone, and 4316 samples for quetiapine). The dose-adjusted concentration was used as the primary target variable. A linear mixed model was used to allow the inclusion of multiple samples from each patient. RESULTS Age had a significant impact on the concentrations of all four drugs. At the age of 80, the dose-adjusted concentrations were up to twice those of the age of 40. At the age of 90, dose-adjusted concentrations were two- to three-fold higher. Age-related increases were largest for clozapine (+108% at 80 years; +197% at 90 years) and smallest for olanzapine (+28% at 80 years; +106% at 90 years). Females generally had dose-adjusted concentrations 20-30% higher than males. CONCLUSION The effect of age on the serum concentrations of the antipsychotics studied becomes pronounced with advanced age. The patient population aged above 70 should be subdivided according to exact age, and considerable dose reductions are recommended.
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Affiliation(s)
- I Castberg
- Østmarka Psychiatric Department, St. Olav University Hospital, Trondheim, Norway
| | - A A Westin
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - E Skogvoll
- Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - O Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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Antipsychotic drug use in nursing home residents with and without dementia: keep an eye on the pro re nata medication. Int Clin Psychopharmacol 2017; 32:213-218. [PMID: 28346296 DOI: 10.1097/yic.0000000000000173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Behavioral and psychological symptoms of dementia often lead to the prescription of antipsychotics, especially in nursing homes, but their use remains controversial. This study aimed to assess antipsychotic drug use in residents with dementia compared with those without dementia. Data were obtained through the cross-sectional 'inappropriate medication in patients with renal insufficiency in nursing homes' (IMREN) study including data from 21 nursing homes. Descriptive statistics were used and factors associated with the prescription of antipsychotics were identified by logistic regression. Overall, 57.5% of the 837 residents had a diagnosis of dementia and 47.0% of residents with dementia and 19.5% of those without dementia received antipsychotics. 35.9% of all antipsychotics in residents with dementia were prescribed as pro re nata (PRN) compared with 23.0% for residents without dementia. Typical antipsychotics were prescribed more commonly than atypical ones. The adjusted logistic regression showed a significant association between the prescription of antipsychotics and dementia (odds ratio: 3.58, 95% confidence interval: 2.45-5.25) as well as severe care dependency (odds ratio: 1.68, 95% confidence interval: 1.10-2.55). Despite safety warnings, antipsychotics are still frequently prescribed to residents with dementia. Almost half received antipsychotics and about a third of the antipsychotics are prescribed as PRN. Further studies should assess the use of PRN antipsychotics and guidelines for PRN prescriptions are clearly needed.
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Backhaus R, van Rossum E, Verbeek H, Halfens RJG, Tan FES, Capezuti E, Hamers JPH. Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities. BMC Health Serv Res 2017; 17:53. [PMID: 28103856 PMCID: PMC5244701 DOI: 10.1186/s12913-016-1947-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. METHODS We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. RESULTS 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. CONCLUSIONS In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.
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Affiliation(s)
- Ramona Backhaus
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Erik van Rossum
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Zuyd University of Applied Sciences, Research Centre on Autonomy and Participation, P.O. Box 550, 6400 AN, Heerlen, The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Ruud J G Halfens
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Frans E S Tan
- Department of Methodology and Statistics, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Elizabeth Capezuti
- Hunter College, City University of New York, Brookdale Campus West, Room 526, 425 E. 25th Street # 925, New York, NY, 10010, USA
| | - Jan P H Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Antipsychotic use in dementia patients in a general practice setting: a Dutch population-based study. Epidemiol Psychiatr Sci 2016; 25:403-6. [PMID: 26988389 PMCID: PMC7137605 DOI: 10.1017/s2045796016000111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Bakken MS, Schjøtt J, Engeland A, Engesaeter LB, Ruths S. Antipsychotic Drugs and Risk of Hip Fracture in People Aged 60 and Older in Norway. J Am Geriatr Soc 2016; 64:1203-9. [DOI: 10.1111/jgs.14162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Marit S. Bakken
- Department of Global Public Health and Primary Care; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Kavli Research Centre for Geriatrics and Dementia; Haraldsplass Deaconess Hospital; Bergen Norway
| | - Jan Schjøtt
- Department of Clinical Science; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Section of Clinical Pharmacology; Laboratory of Clinical Biochemistry; Haukeland University Hospital; Bergen Norway
- Regional Medicines Information and Pharmacovigilance Centre; Haukeland University Hospital; Bergen Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Department of Pharmacoepidemiology; Norwegian Institute of Public Health; Oslo Norway
| | - Lars B. Engesaeter
- Department of Clinical Science; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Norwegian Arthroplasty Registry; Department of Orthopaedics and Department of Clinical Medicine; Haukeland University Hospital; Bergen Norway
| | - Sabine Ruths
- Department of Global Public Health and Primary Care; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Research Unit for General Practice; Uni Research Health; Bergen Norway
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