The impact of nursing home patients on prescribing costs in general practice

Objectives: To compare the costs of prescribing for older people in nursing homes with older people living at home and to compare patterns of prescribing between these two groups. Design: Retrospective case-control study. Setting: Nine general practices in Nottinghamshire. Subjects: Two hundred and seventy patients aged 65 years and over living in nursing homes matched for age, sex and general practice, with 270 patients living in their own homes. Main outcome measures: A comparison of the costs of prescriptions, the number of items on prescription and the types of drugs prescribed between the cases and controls. Results: The mean cost of prescriptions per patient month was almost three times higher for nursing home patients than controls (pound 45.27 compared to pound 16.46). The mean number of items prescribed per patient month was also higher in nursing home patients (5.60 compared to 2.55). Total costs of prescriptions for nursing home patients were higher than for controls (P < 0.0001), as were total numbers of prescription items (P < 0.001). There were differences in the types of medication prescribed between the two groups, including considerably higher costs for central nervous system drugs, ulcer healing drugs, laxatives and enteral nutrition in nursing home residents. Conclusions: When calculating general practice prescribing budgets, nursing home patients should have a greater weighting than other patients of similar age and sex.