Over-the-counter drug use by medicare beneficiaries in nursing homes: Implications for practice and policy

OBJECTIVES: To examine over-the-counter (OTC) medication use by Medicare beneficiaries in nursing homes and to assess evidence of substitution of OTC medications for prescription (Rx) medications by residents with no Rx coverage and Medicaid. DESIGN: Cross-sectional multivariable analysis. SETTING: Medicare beneficiaries included in the nationally representative Medicare Current Beneficiary Survey in 2001. PARTICIPANTS: Seven hundred eighty-nine Medicare beneficiaries with 1 or more months in a nursing home. MEASUREMENTS: Proportions of residents using Rx and OTC medications per resident-month and counts of drugs used within selected therapeutic classes. RESULTS: Study subjects were high users of Rx (98%) and OTC (94%) drugs. The average resident was administered 8.8 unique medications per month (5.9 Rx and 2.9 OTC medications). Twelve therapeutic classes accounted for 93.9% of OTC medication use by residents, but Rx use was also high in some of these same classes. For example, 70.3% of all subjects used nonopioid OTC analgesics, and 19.0% used nonoploid Rx analgesics, and 13.8% used OTC antacids/antiulcer agents, whereas 35.8% used Rx products in this class. The highest overlap was in the category of cough and cold medications, of which 19.3% used OTCs and 20.1% used Rx drugs. Multivariate regression analyses applied to users of drugs in each these three therapeutic classes found no evidence that Rx coverage influenced the choice of OTC versus Rx-only medications. CONCLUSION: OTCs represent an important component of the therapeutic regimens of nursing home residents, but utilization rates are insensitive to drug coverage. That may change with the implementation of the Medicare Part D drug benefit.