Zhan C, Sangl J, Bierman A S, Miller M R, Friedman B, Wickizer S W, Meyer G S
Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, 6011 Executive Blvd, Suite 200, Rockville, MD 20852, USA.
JAMA. 2001 Dec 12;286(22):2823-9. doi: 10.1001/jama.286.22.2823.
Inappropriate medication use is a major patient safety concern, especially for the elderly population. Using explicit criteria, prior studies have found that 23.5% and 17.5% of the US community-dwelling elderly population used at least 1 of 20 potentially inappropriate medications in 1987 and 1992, respectively.
To determine the prevalence of potentially inappropriate medication use in community-dwelling elderly persons in 1996, to assess trends over 10 years, categorize inappropriate medication use according to explicit criteria, and to examine risk factors for inappropriate medication use.
DESIGN, SETTING, AND PARTICIPANTS: Respondents aged 65 years or older (n = 2455) to the 1996 Medical Expenditure Panel Survey, a nationally representative survey of the US noninstitutionalized population were included. A 7-member expert panel was convened to categorize inappropriate medications.
Prevalence of use of 33 potentially inappropriate medications.
In 1996, 21.3% (95% confidence interval [CI], 19.5%-23.1%) of community-dwelling elderly patients in the United States received at least 1 of 33 potentially inappropriate medications. Using the expert panel's classifications, about 2.6% of elderly patients (95% CI, 2.0%-3.2%) used at least 1 of the 11 medications that should always be avoided by elderly patients; 9.1% (95% CI, 7.9%-10.3%) used at least 1 of the 8 that would rarely be appropriate; and 13.3% (95% CI, 11.7%-14.9%) used at least 1 of the 14 medications that have some indications but are often misused. Use of some inappropriate medications declined between 1987 and 1996. Persons with poor health and more prescriptions had a significantly higher risk of inappropriate medication use.
Overall inappropriate medication use in elderly patients remains a serious problem. Despite challenges in using explicit criteria for assessing inappropriate medications for elderly patients, such criteria can be applied to population-based surveys to identify opportunities to improve quality of care and patient safety. Enhancements of existing data sources to include dosage, duration, and indication may augment national improvement and monitoring efforts.
不适当用药是一个主要的患者安全问题，对老年人群体尤为如此。先前的研究使用明确的标准发现，在1987年和1992年，分别有23.5%和17.5%的美国社区居住老年人使用了20种潜在不适当药物中的至少一种。
确定1996年社区居住老年人中潜在不适当用药的患病率，评估10年期间的趋势，根据明确标准对不适当用药进行分类，并检查不适当用药的风险因素。
设计、地点和参与者：纳入了对1996年医疗支出小组调查（一项对美国非机构化人口具有全国代表性的调查）中65岁及以上的受访者（n = 2455）。召集了一个由7名成员组成的专家小组对不适当药物进行分类。
33种潜在不适当药物的使用患病率。
1996年，美国社区居住老年患者中有21.3%（95%置信区间[CI]，19.5% - 23.1%）使用了33种潜在不适当药物中的至少一种。根据专家小组的分类，约2.6%的老年患者（95% CI，2.0% - 3.2%）使用了老年患者应始终避免使用的11种药物中的至少一种；9.1%（95% CI，7.9% - 10.3%）使用了8种很少适用的药物中的至少一种；13.3%（95% CI，11.7% - 14.9%）使用了14种有一些适应证但经常被滥用的药物中的至少一种。1987年至1996年期间，一些不适当药物的使用有所下降。健康状况差和处方较多的人不适当用药的风险显著更高。
老年患者总体上不适当用药仍然是一个严重问题。尽管在使用明确标准评估老年患者不适当用药方面存在挑战，但这些标准可应用于基于人群的调查，以确定改善护理质量和患者安全的机会。增强现有数据源以包括剂量、疗程和适应证可能会加强全国性的改进和监测工作。
