Pittrow David, Krappweis J, Rentsch A, Schindler C, Hach I, Bramlage P, Kirch W
Institute of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Fiedlerstr 27, D-01307 Dresden, Germany.
Pharmacoepidemiol Drug Saf. 2003 Oct-Nov;12(7):595-9. doi: 10.1002/pds.860.
The purpose of this study was to describe the physician prescription pattern for frail elderly patients in German nursing homes and to identify differences, if any, between that of physicians based in the nursing homes (A) and those with office-based practices (B).
Retrospective, longitudinal study of medication prescriptions on the basis of the database of a health insurance (Betriebskrankenkasse) in Berlin, Germany. We assessed the medication prescriptions for all 996 unselected insured individuals aged > or = 60 years who were insured throughout 1999 and lived in nursing homes. We analyzed selected patient characteristics and prescription data. Drugs were classified according to the WHO ATC code and were assigned a mean daily defined dose (DDD).
816 individuals were women and 180 were men. A total of 78% of women and 43% of men were aged 80 years or older. Two hundred sixty three patients were seen by nursing home-based physicians (A) and 733 by office-based physicians (B). The median of prescriptions per patient and year was 31 (A) and 37 (B) (p between groups < 0.001). Patients in Group A also received a lower number of DDDs in comparison to Group B (1109 vs 1250; p < 0.01). Costs were substantially higher in group B, and in both groups higher in the 60-69 years old in comparison to the more senior patients. The prescription pattern suggested a considerable frequency of inappropriate drug use in both groups in the following classes: psychopharmacological agents (neuroleptics, antidepressants, hypnotics), pain medication, digitalis glycosides, laxants and loop diuretics. On an average, office-based physicians (B) prescribed relatively more medications in all major classes with the exception of non-opiate analgesics, laxants and anxiolytics.
These data are indicative of a considerable use of inappropriate medication for frail geriatric patients. Differences between the prescribing pattern among nursing home-based and office-based physicians were not substantial, however, the latter group prescribed relatively more drugs.
本研究旨在描述德国养老院中体弱老年患者的医生处方模式，并确定养老院医生（A组）与门诊医生（B组）的处方模式之间是否存在差异。
基于德国柏林一家健康保险公司（企业医疗保险）的数据库进行回顾性纵向药物处方研究。我们评估了1999年全年参保且居住在养老院的所有996名年龄≥60岁的未选定参保个体的药物处方。我们分析了选定的患者特征和处方数据。药物根据世界卫生组织的解剖学治疗学化学（ATC）代码进行分类，并指定每日平均限定剂量（DDD）。
816人为女性，180人为男性。女性中78%、男性中43%的年龄在80岁及以上。养老院医生（A组）诊治了263名患者，门诊医生（B组）诊治了733名患者。每位患者每年处方的中位数，A组为31，B组为37（组间p<0.001）。与B组相比，A组患者接受的DDD数量也较少（1109对1250；p<0.01）。B组的费用显著更高，且两组中60 - 69岁患者的费用均高于年长患者。处方模式表明两组在以下类别中存在相当频繁的不适当用药情况：精神药物（抗精神病药、抗抑郁药、催眠药）、止痛药、洋地黄苷、泻药和襻利尿剂。平均而言，门诊医生（B组）在所有主要类别中开具的药物相对较多，但非阿片类镇痛药、泻药和抗焦虑药除外。
这些数据表明体弱老年患者存在大量不适当用药情况。养老院医生和门诊医生的处方模式差异不大，但后者开具的药物相对较多。
