Goulding Margie Rauch
Office of Analysis, Epidemiology, and Health Promotion at the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA.
Arch Intern Med. 2004 Feb 9;164(3):305-12. doi: 10.1001/archinte.164.3.305.
Inappropriate medication use in elderly patients has been linked to a large share of adverse drug reactions and to excess health care utilization.
Trends in the prevalence of potentially inappropriate drug prescribing at ambulatory care visits by elderly persons from 1995 to 2000 were examined with data from office-based physicians in the National Ambulatory Medical Care Survey and from hospital outpatient departments in the National Hospital Ambulatory Medical Care Survey. Explicit criteria were used to identify potentially inappropriate prescribing. Multivariate regression was used to identify related factors.
In 1995 and 2000, at least 1 drug considered inappropriate by the Beers expert panel was prescribed at 7.8% of ambulatory care visits by elderly patients. At least 1 drug classified as never or rarely appropriate by the Zhan expert panel was prescribed at 3.7% and 3.8% of these visits in 1995 and 2000, respectively. Pain relievers and central nervous system drugs were a large share of the problem. The odds of potentially inappropriate prescribing were higher for visits with multiple drugs and double for female visits. The latter was due to more prescribing of potentially inappropriate pain relievers and central nervous system drugs.
Potentially inappropriate prescribing at ambulatory care visits by elderly patients, particularly women, remains a substantial problem. Interventions could target more appropriate drug selection by physicians when prescribing pain relievers, antianxiety agents, sedatives, and antidepressants to elderly patients. Such behavior could eliminate a large portion of inappropriate prescribing for elderly patients and reduce its higher risk for women.
老年患者不适当用药与很大一部分药物不良反应以及医疗资源的过度利用有关。
利用国家门诊医疗调查中基层医生的数据以及国家医院门诊医疗调查中医院门诊部的数据，研究了1995年至2000年老年患者在门诊就诊时潜在不适当药物处方的流行趋势。采用明确的标准来识别潜在不适当的处方。使用多变量回归来识别相关因素。
1995年和2000年，在老年患者的门诊就诊中，有7.8%的就诊开具了至少一种被比尔斯专家小组认为不适当的药物。1995年和2000年，在这些就诊中，分别有3.7%和3.8%的就诊开具了至少一种被詹专家小组归类为从不或很少适当的药物。止痛药和中枢神经系统药物是问题的很大一部分。开具多种药物的就诊潜在不适当处方的几率更高，女性就诊的几率则翻倍。后者是由于潜在不适当的止痛药和中枢神经系统药物的处方更多。
老年患者，尤其是女性，在门诊就诊时潜在不适当处方仍然是一个严重问题。干预措施可以针对医生在为老年患者开具止痛药、抗焦虑药、镇静剂和抗抑郁药时选择更合适的药物。这种行为可以消除老年患者很大一部分不适当处方，并降低女性较高的风险。
