Physician Contacts and Their Influence on the Appropriateness of Pain Medication in Nursing Home Residents: A Cross-Sectional Study

Objectives: This study assessed the frequency of physician contacts for individual nursing home residents (NHRs) and investigated whether the frequency of contacts influences the appropriateness of pain medication in NHRs. Design: Observational cross-sectional study conducted between March 2009 and April 2010. Setting: Forty nursing homes in Berlin and Brandenburg, Germany. Participants: A total of 560 NHRs. Measurements: The number and type of NHR physician contacts were obtained by face-to-face interviews. To assess the appropriateness of pain medication, the German version of the Pain Medication Appropriateness Scale (PMAS(D)) was used. The influence of physician contacts on the appropriateness of pain medication was calculated with a linear mixed-effect model. Results: The proportions of NHRs with at least 1 contact with their attending physicians were 61.8% (primary care physicians), 55.2% (general practitioners), 9.6% (neurologists), 9.4% (other), 5.4% (internists), 2.2% (orthopedic surgeons), and 0.7% (psychiatrists). The number of all physician contacts correlated weakly with the appropriateness of pain medication (r=0.166, P=.039). With every physician contact, the PMAS(D) score rose by about 2 points (P=.056). Conclusions: Physician care in German nursing homes is mainly provided by primary care physicians. A higher number of physician contacts had a modest impact on more appropriate pain medication use. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.