Rochon Paula A, Lane Christopher J, Bronskill Susan E, Sykora Kathy, Anderson Geoffrey M, Mamdani Muhammad M, Gurwitz Jerry H, Dhalla Irfan A
Kunin-Lunenfeld Applied Research Unit, Department of Medicine, University of Toronto, Baycrest Centre for Geriatric Care, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Drugs Aging. 2004;21(14):939-47. doi: 10.2165/00002512-200421140-00004.
To explore the prescribing of potentially inappropriate drug therapy in Ontario, Canada where there is a restrictive drug formulary relative to the US where there is no single drug formulary.
A retrospective, cohort study using an administrative database (Ontario, Canada) compared with published survey results (US). All 1,088,680 community-dwelling adults >or=66 years of age in Ontario, Canada compared with published survey results from 2455 community-dwelling older adults in the US in 1996. Patterns of potentially inappropriate drug prescribing were compared between countries using a list of 33 potentially inappropriate drug therapies. These therapies were classified by an expert panel into three categories: (i) those to always avoid; (ii) those which are rarely appropriate; and (iii) those with only some indications to prescribe.
Among the 33 potentially inappropriate drug therapies, 15 (45%) prescribed in the US were not available through Ontario's drug formulary. Potentially inappropriate drug therapies available through the Ontario Drug Benefit Plan (ODB) and also in the US were frequently prescribed in both Ontario and the US. Differences in prescribing patterns of individual drug therapies were noted between the two countries. Specifically, in the rarely appropriate category, diazepam, a long half-life benzodiazepine, was much more frequently dispensed in Ontario than in the US (3.18% vs 1.37%). In contrast, dextropropoxyphene, an opioid with a poor adverse event profile was more frequently prescribed in the US than in Ontario (6.21% vs 0.74%).
Almost half of the potentially inappropriate drug therapies that are available in the US are unavailable from Ontario's drug formulary. Potentially inappropriate drug therapies that were available through the ODB were frequently prescribed in both countries. Alternative approaches that make information immediately accessible to physicians at the time they make prescribing decisions should be considered to improve prescribing practices.
在加拿大安大略省，其药品处方集相对美国而言具有限制性，而美国没有单一的药品处方集，本研究旨在探究安大略省潜在不适当药物治疗的处方情况。
采用行政数据库（加拿大安大略省）进行回顾性队列研究，并与已发表的调查结果（美国）进行比较。研究对象为加拿大安大略省所有1,088,680名年龄≥66岁的社区居住成年人，并与1996年美国2455名社区居住老年人的已发表调查结果进行比较。使用33种潜在不适当药物治疗清单比较两国间潜在不适当药物处方模式。这些治疗方法由一个专家小组分为三类：（i）应始终避免使用的；（ii）很少适用的；（iii）仅有某些用药指征的。
在33种潜在不适当药物治疗中，美国使用的15种（45%）无法通过安大略省的药品处方集获得。通过安大略省药品福利计划（ODB）且在美国也有的潜在不适当药物治疗在安大略省和美国都经常被处方。两国在个别药物治疗的处方模式上存在差异。具体而言，在很少适用的类别中，半衰期长的苯二氮䓬类药物地西泮在安大略省的配药频率远高于美国（3.18%对1.37%）。相比之下，不良事件谱较差的阿片类药物右丙氧芬在美国的处方频率高于安大略省（6.21%对0.74%）。
美国可用的潜在不适当药物治疗中，近一半无法从安大略省的药品处方集中获得。通过ODB可用的潜在不适当药物治疗在两国都经常被处方。应考虑采用替代方法，使医生在做出处方决策时能立即获取信息，以改善处方行为。
