ADEs are common in the Australian health system. Anticoagulant, anti-inflammatory, and cardiovascular drugs feature prominently as preventable, high impact problems, and collectively make up over one-half of all ADEs. Methods for monitoring and preventing ADEs should be progressively improved.

Objective: To implement and evaluate a collaborative medication management service model. Design: Participatory action research. Setting and participants: The study was conducted from March 1999 to March 2000; 1000 patients, 63 pharmacists and 129 general practitioners from six Divisions of General Practice in South Australia participated. Interventions:A collaborative service delivery model, involving a preliminary case conference, a home visit and a second case conference, was agreed through discussions with medical and pharmacy organisations and then implemented. Outcome measures: Medication-related problems; actions recommended; actions implemented; and outcomes after actions taken. Results: Overall, 2764 problems were identified. The most common medicationrelated problem (17.5% of all problems) was the need for additional tests. Thirtyseven per cent of problems related to medicine selection, 20% to patient knowledge, and 17% to the medication regimen. Of 2764 actions recommended to resolve medication-related problems, 42% were implemented. Of the 978 problems for which action was taken and follow-up data were available, 81% were reported to be "resolved", "well managed" or "improving". Conclusion: This implementation model was successful in engaging GPs and MJA 2002; 177: 189-192 pharmacists and in assisting in the resolution of medication-related problems.

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The quality of nursing home care for older people, including medication use and related outcomes, has been problematic in a number of developed countries. This paper compares the policy approaches to drug prescribing and administration in nursing homes adopted by four countries. The United States has led the way in terms of regulating and inspecting nursing homes, with strict requirements for prescribing psychotropic medications, commonly known as "chemical restraints." These requirements have been facilitated by detailed data collection mandated by the US government. Although regulation has led to marked reductions in the prescribing of these agents, underused medications have received little attention. Despite similar problems with the use of psychotropic drugs, the United Kingdom, Australia and New Zealand have adopted a more generic approach to drug use in the nursing home setting, a situation that may reflect the different organization and ethos of healthcare systems in these countries. Developments in systematic medication data capture, greater collaboration and more educational feedback to prescribers and facilities would represent a major step forward in long-term care policy in these latter three countries, while a broader educational focus would further support improvements in the US setting. RésuméLa qualité des soins dispensés dans les foyers pour personnes âgées est problématique dans plusieurs pays développés, et cette préoccupation s' est étendue à l'utilisation des médicaments et aux effets connexes. Le présent article compare les politiques adoptées par quatre pays à ce chapitre. Les États-Unis ont pris les devants en matière de régle-mentation et d'inspection des foyers pour personnes âgées et ont adopté des exigences strictes concernant la prescription de médicaments psychotropes, communément appelés « contraintes chimiques ». Ces exigences s' appuient sur une collecte de données détaillées, effectuée à la demande du gouvernement américain. Bien que la réglementa-tion ait mené à une réduction marquée du nombre d' ordonnances de ces agents, les médicaments sous-utilisés n' ont pas fait l' objet d'une promotion très musclée. Même s'ils ont eu des problèmes semblables avec l'utilisation des médicaments psychotropes, le Royaume-Uni, l' Australie et la Nouvelle-Zélande ont adopté une approche beaucoup plus générique en ce qui concerne l'utilisation des médicaments dans les foyers pour personnes âgées -approche qui reflète peut-être l' organisation et l' éthos différents qui caractérisent les systèmes de santé de ces pays. Les progrès réalisés dans la capture systématique des données sur les médicaments, une collaboration accrue et une rétroaction plus informative aux prescripteurs et aux établissements constitueraient un grand pas en avant dans les politiques sur les soins de longue durée dans ces trois pays, tandis qu'un accent accru sur l' éducation favoriserait l' apport d' améliorations dans le contexte états-unien. (Hughes and Lapane 2005). Policies to influence medication use in resi...

Objective: To determine the proportion of drug-related hospital admissions which are correctly coded in the medical record. Design: A retrospective review of medical records codes associated with admissions which had been independently identified as drug-related in two teaching hospitals. Results: Known adverse drug reactions were coded as drug-related admissions in 11 % of cases in one hospital and in 31 % of cases in the other. Codes identifying admissions associated with non-compliance were seldom recorded. In cases where medical records were coded as drug-related admissions, the diagnosis codes and drug class codes were usually accurate. Conclusion: The data recorded through the hospital morbidity collection provide the only systematic method available in this country to monitor drug-related morbidity which results in hospitalisation, but the results of this study demonstrate that it is inadequate for this purpose. Urgent modification to this system is necessary to provide pharmacoepidemiological data for identifying patterns of inappropriate drug use which need to be targeted to improve health outcomes. Aust} Hosp Phann 1998; 28: 7-12. INTRODUCTIONThe incidence of preventable drug-related hospital admissions is an important indication of the quality of medication use in the community. Recent studies assessing drug-related hospital admissions have estimated that between 2.4% 1 and 3.6% 2 of all general hospital admissions are drug-related and that between 32% and 69% of these admissions are avoidable.