Veehof L, Stewart R, Haaijer-Ruskamp F, Jong B M
Department of General Practice and Northern Centre of Health Care, University of Groningen, Groningen, The Netherlands.
Fam Pract. 2000 Jun;17(3):261-7. doi: 10.1093/fampra/17.3.261.
To date, only a few studies have been carried out on the development and progress of polypharmacy in relation to morbidity in general practices in The Netherlands.
The aim of this study was to investigate the relationship between an increase in long-term drug use and the incidence and severity of some chronic diseases, particularly in the elderly.
Data on medication and morbidity of 1544 elderly people were collected for the period 1994-1997 from three family practices in the medication and morbidity Registration Network of Groningen (RNG) in the northern part of The Netherlands. Polypharmacy is defined as the long-term simultaneous use of two or more drugs; long-term is defined as >240 days in a year. We looked for differences in incidences of some chronic diseases in those subgroups of the elderly in whom multiple long-term drug use respectively increased, stayed constant or did not exist. Polypharmacy at the end of the period was predicted using regression analysis.
Polypharmacy occurred in 42% of the elderly at the end of 1997, with major polypharmacy (>5 drugs) in only 4%. The average number of drugs used long-term increased from 1.3 to 1.8 in 4 years. Predictors for the increase of polypharmacy were the number of drugs at the start, age, diabetes, coronary ischaemic diseases and use of medication without a clear indication (P < 0.005). The average number of diseases also increased, especially in the elderly who showed the greatest increase in long-term drug use; however, there was no significant difference from the groups with a slow or no increase in drug use.
Polypharmacy showed a slow increase over 4 years: almost 20% of the elderly developed polypharmacy, i.e. going from no drugs or one drug to two or more drugs. Polypharmacy develops mainly in elderly patients who already use several drugs, who are known to suffer from cardiovascular diseases, diabetes or stomach symptoms, those who often take drugs (especially sedatives/hypnotics) without clear indication and those who develop hypertension or atrial fibrillation over time.
迄今为止，在荷兰，关于综合药物治疗的发展及进展与全科医疗中发病率之间的研究仅有少数几项。
本研究旨在调查长期用药增加与某些慢性病的发病率及严重程度之间的关系，尤其是在老年人中。
1994年至1997年期间，从荷兰北部格罗宁根药物与发病率登记网络（RNG）的三个家庭医疗中心收集了1544名老年人的用药和发病数据。综合药物治疗定义为长期同时使用两种或更多药物；长期定义为一年中超过240天。我们在长期使用多种药物分别增加、保持不变或不存在的老年亚组中寻找某些慢性病发病率的差异。使用回归分析预测该时期末的综合药物治疗情况。
1997年末，42%的老年人存在综合药物治疗情况，其中重度综合药物治疗（>5种药物）仅占4%。4年中，长期使用药物的平均数量从1.3种增加到了1.8种。综合药物治疗增加的预测因素包括起始用药数量、年龄、糖尿病、冠状动脉缺血性疾病以及无明确指征用药（P < 0.005）。疾病的平均数量也有所增加，尤其是在长期用药增加最多的老年人中；然而，与用药增加缓慢或未增加的组相比，并无显著差异。
综合药物治疗在4年中呈缓慢增加趋势：近20%的老年人出现了综合药物治疗情况，即从不用药或使用一种药物转变为使用两种或更多药物。综合药物治疗主要发生在已经使用多种药物、已知患有心血管疾病、糖尿病或胃部症状的老年患者中，发生在经常无明确指征用药（尤其是镇静剂/催眠药）的患者中，以及随着时间推移出现高血压或心房颤动的患者中。
