Harkness Project Title:Evaluation of Prescribing and Related Clinical Outcomes in U.S. Nursing Homes as a Basis for U.K. Models
Mentor: Vincent Mor, Ph.D.
Placement: Center for Gerontology and Health Care Research, Brown University
Biography at time of Harkness Fellowship: Carmel Hughes, a 1998-99 Commonwealth Fund Harkness Fellow in Health Care Policy, is a lecturer in Pharmacy Practice at the School of Pharmacy, The Queen's University of Belfast where she has taught full-time and conducted research since 1997. Her primary research interests are in the care of the elderly, the interface between general practitioners and pharmacists, rational prescribing and drug misuse. Dr. Hughes qualified as a pharmacist in 1988 and received her Ph.D. in pharmacology in 1991. Previously, she was appointed to a part-time lectureship in pharmacy and seconded to the Eastern Health and Social Services Board (Northern Ireland) as a Prescribing Advisor, where she provided prescribing support and advice to general practitioners. She is active in professional pharmaceutical activities through commitments to a number of continuing education/professional development programs for pharmacists, and still practices in community settings.
Project: For her project, Hughes examined the impact of the 1987 Omnibus Budget Reconciliation Act (OBRA 87) on prescribing trends of psychoactive drugs (i.e., chemical restraints) in U.S. nursing homes, and whether these trends have resulted in better outcomes for residents. She first conducted a literature review on the impact of the legislation on nursing homes, and then undertook an international comparison of psychoactive drug use in the U.S. versus Denmark, Sweden, Iceland, Japan, and Italy. For U.S. data, she used the Minimum Data Set and the Online Survey Certification and Automated Record.
Career Activity Since Fellowship:
Current Position: Professor in Primary Care Pharmacy, School of Pharmacy, Queen's University, Belfast (Updated 1/2014)
Millar, A. N., Hughes, C. M., Passmore, A. P. & Ryan, C. “Intermediate Care: The Role of Medicines Management,” Drugs & Aging, 2013.
Clyne, B., Bradley, M. C., Hughes, C. M., Clear, D., McDonnell, R., Williams, D., Fahey, T. & Smith, S. M. “Addressing potentially inappropriate prescribing in older patients: development and pilot study of an intervention in primary care (the OPTI-SCRIPT study),” BMC Health Services Research. 2013.
Parsons, C., McCorry, N., Murphy, K., Byrne, S., O'Sullivan, D., O'Mahony, D., Passmore, P., Patterson, S. & Hughes, C. “Assessment of factors that influence physician decision making regarding medication use in patients with dementia at the end of life,” International Journal of Geriatric Psychiatry, 2013.
De Witt Jansen, B., Weckmann, M., Nguyen, C. M., Parsons, C. & Hughes, C. M. “A cross-national cross-sectional survey of the attitudes and perceived competence of final-year medicine, nursing and pharmacy students in relation to end-of-life care in dementia,” Palliative Medicine, 2013.
Hughes, C. M. & Tunney, M. M. “Improving Prescribing of Antibiotics in Long-term Care: Comment on "Prolonged Antibiotic Treatment in Long-term Care," JAMA internal medicine 2013.
Stewart, D., MacLure, K., Paudyal, V., Hughes, C., Courtenay, M. & McLay, J. “Non-medical prescribers and pharmacovigilance: participation, competence and future needs,” International journal of clinical pharmacy, 2013.
Wilson, J. C., Murray, L. J., Hughes, C. M., Black, A. & Anderson, L. A. “Non-steroidal anti-inflammatory drug and aspirin use and the risk of head and neck cancer,” British Journal of Cancer, 2013 108, 5, p. 1178-81.
Maguire, A., Hughes, C., Cardwell, C. & O'Reilly, D. “Psychotropic medications and the transition into care: a national data linkage study,” Journal of the American Geriatrics Society 2013 61, 2, p. 215-21.
Barry, H. E., Parsons, C., Passmore, A. P. & Hughes, C. M. “Community pharmacists and people with dementia: a cross-sectional survey exploring experiences, attitudes, and knowledge of pain and its management,” International Journal of Geriatric Psychiatry, 2013.
Bannon, F. J., Gavin, A. T., O'Rorke, M. A., Murray, L. J., Cardwell, C. R., Hughes, C. M. & Fleming, S. J. “Non-steroidal anti-inflammatory drug use and brain tumour risk: a case-control study within the Clinical Practice Research Datalink,” Cancer Causes and Control 2013 p. 1-8.
O'Sullivan, D. P., O'Mahony, D., Parsons, C., Hughes, C., Murphy, K., Patterson, S. & Byrne, S. “A prevalence study of potentially inappropriate prescribing in Irish long-term care residents,”Drugs & Aging 2013; 30, 1, p. 39-49.
Clyne, B., Bradley, M. C., Smith, S. M., Hughes, C. M., Motterlini, N., Clear, D., McDonnell, R., Williams, D., Fahey, T. & OPTI-SCRIPT study team “Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: a cluster randomized trial (OPTI-SCRIPT study protocol),” Trials 2013 ; 14, p. 72.
Alldred, D. P., Raynor, D. K., Hughes, C., Barber, N., Chen, T. F. & Spoor, P “Interventions to optimise prescribing for older people in care homes,” Cochrane database of systematic reviews (Online) 2013; 2.
Reid, J., Hughes, C., Murray, L., Parsons, C. & Cantwell, M. “Non-steroidal Anti-inflammatory drugs for the treatment of cancer cachexia: A systematic review,” Palliative Medicine, 2013; 27, 4, p. 295-303.
Patterson, L., Patterson, C., Kee, F., Hughes, C., Donnelly, M. & O'Reilly, D “Prescribing for weight loss in primary care: evidence from a population based study,” Journal of Epidemiological Community Health. 2013; 67, p. 530-532.
Hanna, L-A. & Hughes, C. “The influence of evidence-based medicine training on decision-making in relation to over-the-counter medicines: a qualitative study,” The International Journal of Pharmacy Practice 2012; 20, 6, p. 358-366.
Bradley, M., Fahey, T., Cahir, C., Bennett, K., O'Reilly, D., Parsons, C. & Hughes, C “Potentially inappropriate prescribing and cost outcomes for older people: a cross sectional study using the Northern Ireland Enhanced Prescribing Database,” European Journal of Clinical Pharmacology 2012 ;68, 10, p. 1425-1433.
McClean, P., Tunney, M., Parsons, C., Gilpin, D., Baldwin, N. & Hughes, C. “Infection control and meticillin-resistant Staphylococcus aureus decolonization: the perspective of nursing home staff,” The Journal of hospital infection 2012; 81, 4, p. 264-9.
McClean, P., Tunney, M., Gilpin, D., Parsons, C. & Hughes, C., “Antimicrobial prescribing in residential homes,” Journal of Antimicrobial Chemotherapy 2012 67, 7, p. 1781-1790.
Glover, J. A., Murray, L. J., Bannon, F. J., Gavin, A., Hughes, C. M., Cantwell, M. M., Comber, H. & Deady, S “Increased diagnosis and detection rates of carcinoma in situ of the breast,” Breast Cancer Research and Treatment 2012; 133, 2, p. 779-784.
Clyne, B., Bradley, M., Hughes, C., Fahey, T. & Lapane, K. L. “Electronic prescribing and other forms of technology to reduce inappropriate medication use and polypharmacy in older people: a review of current evidence,” Clinics in Geriatric Medicine 2012; 28, 2, p. 301-322.
McCann, L., Lloyd, F., Parsons, C., Gormley, G., Haughey, S., Crealey, G. & Hughes, C. Mar "They come with multiple morbidities": a qualitative assessment of pharmacist prescribing,” Journal of Interprofessional Care 2012; 26, 2, p. 127-33.
McMenamin, U., Murray, L., Cantwell, M. & Hughes, C. “Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in cancer progression and survival: a systematic review,” Cancer Causes and Control 2012; 23, 2, p. 221-230.
Bradley, M. C., Murray, L. J., Cantwell, M. M. & Hughes, C. M. “Proton pump inhibitors and histamine-2-receptor antagonists and pancreatic cancer risk: a nested case-control study,” British Journal of Cancer 2012; 106, 1, p. 233-239.
Cardwell, C., Abnet, C. C., Veal, P., Hughes, C., Cantwell, M. & Murray, L “Exposure to oral bisphosphonates and risk of cancer,” International Journal of Cancer 2012 131, 5.
Hughes, C., Donnelly, A., Moyes, S., Peri, K., Scahill, S., Chen, C., McCormack, B. G. & Kerse, N. ‘The way we do things around here’: an international comparison of treatment culture in nursing homes,” Journal of the American Medical Directors Association 2012; 13, p. 360-367.
McCann, L. M., Haughey, S. L., Parsons, C., Lloyd, F., Crealey, G., Gormley, G. J. & Hughes, C. M “ A patient perspective of pharmacist prescribing: 'crossing the specialisms-crossing the illnesses'” Health expectations : an international journal of public participation in health care and health policy, 2012.
Heather, B., Parsons, C., Passmore, P. & Hughes, C. “An exploration of nursing home managers’ knowledge of and attitudes towards the management of pain in residents with dementia,” International Journal of Geriatric Psychiatry 2012; 27, p. 1258-1266.
Barr, P., McElnay, J. & Hughes, C. “Connected healthcare: the future of health care and the role of the pharmacist,” Journal of Evaluation in Clinical Practice 2012; 18, p. 56-62.
Rubio-Valera, M., Jové, A. M., Hughes, C. M., Guillen-Solà, M., Rovira, M. & Fernández, A “Factors affecting collaboration between general practitioners and community pharmacists: a qualitative study,” BMC health services research 2012; 12, p. 188.
Patterson, S. M., Hughes, C., Kerse, N., Cardwell, C. R. & Bradley, M. C. “Interventions to improve the appropriate use of polypharmacy for older people,” Cochrane database of systematic reviews (Online). 5, 2012.
Hanna, L-A., Hughes, C. & Watson, M. “Where's the evidence? Over-the-counter medicines and pharmacy practice,” The International Journal of Pharmacy Practice 2012; 20, 5, p. 275-276.
Hanna LA, Hughes CM. “Pharmacists' attitudes towards an evidence-based approach for over-the-counter medication.” Int J Clin Pharm. 2011 Nov 23.
Rubio-Valera M, Fernández A, Luciano JV, Hughes CM, Pinto-Meza A, Moreno-Küstner B, Palao DJ, Haro JM, Serrano-Blanco A. “Psychotropic prescribing in primary care in Catalonia--results from an epidemiological study.” Fam Pract. 2011 Sep 15.
McCann L, Haughey S, Parsons C, Lloyd F, Crealey G, Gormley GJ, Hughes CM. “Pharmacist prescribing in Northern Ireland: a quantitative assessment.” Int J Clin Pharm. 2011 Oct;33(5):824-31.
Hughes C, Lapane K, Kerse N. Prescribing for older people in nursing homes: challenges for the future. Int J Older People Nurs. 2011 Mar;6(1):63-70.
Hughes CM. “Compliance With Medication in Nursing Homes For Older People: Resident Enforcement or Resident Empowerment?” Drugs and Aging 2010 Jun 1;27(6):435-49.
Hughes CM, Hawwa AF, Scullin C, et al. “Provision of pharmaceutical care by community pharmacists: a comparison across Europe.” Pharm
World Sci. 2010 Aug;32(4):472-87.
Patterson SM, Hughes CM, Crealey G, Cardwell C, Lapane K. “An evaluation of an adapted United States model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood NI Study).” Journal of the American Geriatrics Society 2010 Jan;58(1):44-53.
Hughes CM, Roughead E, Kerse N. “People in Long-Term Care: Contrasting the Policy Approaches of Four Countries,” Healthcare Policy 2008; 3(3):37–51.
Spinewine A, Schmader KE, Barber N, Hughes CM, Lapane KL, Swine C, Hanlon JT. “Appropriate Prescribing in Elderly People: How Well Can It Be Measured and Optimised?” The Lancet 2007; 370: 173-184
Lapane KL, Quilliam BJ, Hughes CM. “A Comparison of Two Distribution Methods On Response Rates to a Patient Safety Questionnaire in Nursing Homes,” Journal of the American Medical Directors Association 2007; 8: 446-452
Lapane KL, Hughes CM. “Considering the employee point of view: perceptions of job satisfaction and stress among nursing staff in nursing homes.” Journal of the American Medical Directors’ Association 2007; 8: 8-13
Hughes, CM, Lapane KL, Watson CM, Davies, HTO. “Does Organisational Culture Influence Prescribing in Care Homes for Older People?” Drugs and Aging 2007; 24(2): 81.
Hughes CM. “Preventing Adverse Drug Events in Nursing Home Residents,” Aging Health 2007; 3: 15-22.
Patterson, S.P., Hughes, C.M., Lapane, K.L., “Assessment of a United States Pharmaceutical Care Model for Nursing Homes in the United Kingdom, “ Pharmacy World and Science 2007; 29(5): 517-25.
Lapane, K.L., Hughes, C.M., Quilliam, B.J., “Does Incorporating Medications in the Surveyors’ Interpretive Guidelines Reduce the Use of Potentially Inappropriate Medications in Nursing Homes?” Journal of the American Geriatrics Society, 2007 55(5): 666-73.
Lapane KL, Hughes CM. “Deconstructing racial differences in receipt of secondary stroke prevention agents in nursing homes.” Journal of Aging and Pharmacotherapy 2006; 13: 53-66
Lapane KL, Hiris J, Hughes CM, Feinberg J. „Development and implementation of pharmaceutical care planning software for nursing homes based on the Fleetwood model.” American Journal of Health-System Pharmacy 2006; 63: 2483-2489
Lapane KL, Hughes CM. “Pharmacotherapy interventions undertaken by pharmacists in the Fleetwood Phase III study: the role of process control.” Annals of Pharmacotherapy 2006; 40: 1522-1526
Lapane KL, Hughes CM. “Do perceptions of patient safety in nursing homes differ by length of employment, employee type, and shift worked?” The International Journal for Quality in Health Care 2006; 18: 281-286
Lapane KL, Hughes CM. “Job satisfaction and stress among pharmacists in the long-term care sector.” The Consultant Pharmacist 2006; 21: 287-292
Lapane, K.L., Hughes, C.M., “Did the Introduction of a Prospective Payment System for Nursing Home Stays Reduce the Likelihood of Pharmacologic Management of Secondary Ischemic Stroke?” Drugs And Aging, 2006 23:61-69
Hughes, C.M., Wright, R.M., Lapane, K.L., “Use of Medication Technicians in US Nursing Homes: Part of the Problem or Part of the Solution?” Journal of the American Medical Directors’ Association, 2006 7:294-304
Hughes CM, Lapane KL. “Administrative initiatives to reduce inappropriate prescribing of psychotropics in nursing homes: how successful have they been?” Drugs and Aging 2005; 22: 339-351
Lapane, K.L., Hughes, C.M. "Which Organizational Characteristics Are Associated With Increased Management of Depression Using Antidepressants in U.S. Nursing Homes?" Medical Care 42, 10 (October 2004): 992-1000.
Lapane, K.L., Hughes, C.M. “An Evaluation of the Impact of the Prospective Payment System on Antidepressant Use in Nursing Home Residents.” Medical Care 2004; 42:48-58.
Hughes CM, Lapane KL. “Factors associated with the initiation and discontinuation of secondary stroke prevention agents in nursing homes.” Journal of Stroke and Cerebrovascular Disease 2004; 13: 164-170
Lapane KL, Hughes CM. “Identifying nursing home residents at high-risk for preventable adverse drug events: modifying a tool for use in the Fleetwood Phase III study.” Consultant Pharmacist 2004; 19: 533-537
O’Neill C, Sweitzer A, Hughes C, Jamison J, “Cost of Pharmacological Care of the Elderly: Implications for Health Care Resources,” Drugs and Ageing 2003; 20(4):253-61.
Hughes CM, Patterson S, Schweizer AK. “Information is care: the need for data to assess the quality of care in UK nursing and residential homes,” Expert Opinion in Drug Safety, 2003; 2: 523-527
Hughes CM, Lapane KL, “The drive for quality care in US nursing homes in the era of the Prospective Payment System,” Drugs and Aging 2002; 19: 623-631
Lapane, K.L., Hughes, C.M. “Optimizing Drug Utilization in Long-Term Care: The Case of Coronary Heart Disease.” Pharmacoeconomics 2002; 20: 143-152.
Lapane, K.L., Hughes, C.M. “Are Organisational Characteristics Associated With Decreased Use of Selective Serotonin Reuptake Inhibitors (Ssris) for The Management of Depression in US Nursing Homes?” Pharmacoepidemiology and Drug Safety 2002; 11 (Suppl 1): S34.
Van Haaren AM, Lapane KL, Hughes CM. “The effect of triplicate benzodiazepine prescribing policy on the use of benzodiazepines in a frail nursing home population,” Pharmacotherapy 2001; 21: 1159-1166.
Schweizer AK, Hughes CM. “Nursing and residential care for the elderly: the contribution of the pharmacist,” Pharmacy World and Science 2001; 23: 195-199
Hughes, C.M. “Drug Use in Nursing Homes: Legislating for Quality.” Geriatrics and Aging 2001; 4: 8-11.
Schweizer, A., Curry, N., Hughes, C.M. “Pharmaceutical Inspections in Nursing and Residential Homes: An Assessment of the Recommendations.” International Journal of Pharmacy Practice 2001; 9:R62.
Hughes, C.M., “Quality of Care: Should We Legislate or Educate? The Nursing Home Arena as a Case Study. Quality in Health Care.” Strategic Issues In Health Care Management Davies HTO, Tavakoli M, Malek M. Eds. Ashgate, Aldershot, 2001; 79-90 .
Hughes, C.M., Lapane, K.L., Mor, V. “Influence of Facility Characteristics on Antipsychotic Medications in Nursing Homes.” Medical Care. 2000; 38:1164-1174.
Hughes, C.M. “Long-Term Care of the Elderly: Challenges in Pharmaceutical Care.” Journal Of Social And Administrative Pharmacy 2000; 17:66-71.
Hughes, C.M., Lapane, K.L., Mor, V., Ikegami, N., Jonsson, P., Ljunggren, G., Sgadari, A. “The Impact of Legislation on Psychotropic Drug Use in Nursing Homes: A Cross-National Perspective.” Journal of the American Geriatrics Society 2000; 48:931-937.
Hughes, C.M. “Psychotropic Drug Use in Nursing and Residential Homes.” Nursing and Residential Care 2000; 2:285-288.
Hughes, C.M., Lapane, K.L., Mor, V. “The Impact of Legislation on Nursing Home Care in the United States: Lessons for the United Kingdom.” BMJ1999; 319:1060-1063.
Hughes, C.M., Lapane, K.L., Mor, V., “The Impact of Legislation on Psychotropic Drug Use in Nursing Homes: A Cross-National Comparison.” Pharmacoepidemiology And Drug Safety 1999; 8:S116.