In fact, ASCP believes that the underuse of needed and appropriate medications is a more significant problem than overuse of medications. Undertreatment of pain, depression, and osteoporosis have all been documented. In addition, underuse of certain medications, such as ACE inhibitors in residents with heart failure and warfarin in residents with atrial fibrillation, has also been documented. The research and development of the quality indicator on nine or more medications was conducted in the early 1990s. However, the nursing facility environment has changed considerably in the last five to ten years.
Residents now are sicker and generally require more medications.
In addition, the patterns of use of medications have changed. These newer medications often are generally safer and have fewer side effects than the older drugs. As another example, the management of heart failure now routinely includes the use of four types of medications, a diuretic, digoxin, an ACE inhibitor, and a beta blocker. It is questionable if the quality indicator on nine or more medications still has validity in today's environment. In view of the above, ASCP strongly urges HCFA to abandon the use of the quality indicator on nine or more medications.