Hajjar Emily R, Hanlon Joseph T, Sloane Richard J, Lindblad Catherine I, Pieper Carl F, Ruby Christine M, Branch Laurence C, Schmader Kenneth E
Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Pennsylvania 19104, USA.
J Am Geriatr Soc. 2005 Sep;53(9):1518-23. doi: 10.1111/j.1532-5415.2005.53523.x.
To determine the prevalence and predictors of unnecessary drug use at hospital discharge in frail elderly patients.
Cross-sectional.
Eleven Veterans Affairs Medical Centers.
Three hundred eighty-four frail older patients from the Geriatric Evaluation and Management Drug Study.
Assessment of unnecessary drug use was determined by the consensus of a clinical pharmacist and physician pair applying the Medication Appropriateness Index to each regularly scheduled medication at hospital discharge. Those drugs that received an inappropriate rating for indication, efficacy, or therapeutic duplication were defined as unnecessary.
Forty-four percent of patients had at least one unnecessary drug, with the most common reason being lack of indication. The most commonly prescribed unnecessary drug classes were gastrointestinal, central nervous system, and therapeutic nutrients/minerals. Factors associated (P<.05) with unnecessary drug use included hypertension (adjusted odds ratio (AOR)=0.61, 95% confidence interval (CI)=0.38-0.96), multiple prescribers (AOR=3.35, 95% CI=1.16-9.68), and nine or more medications (AOR=2.24, 95% CI=1.25-3.99).
A high prevalence of unnecessary drug use at discharge was found in frail hospitalized elderly patients. Additional studies are needed to identify predictors and prevalence of unnecessary drug use in nonveteran populations so that interventions can be designed to reduce the problem.
确定体弱老年患者出院时不必要药物使用的患病率及预测因素。
横断面研究。
11家退伍军人事务医疗中心。
来自老年评估与管理药物研究的384名体弱老年患者。
由临床药剂师和医生组成的小组根据药物适宜性指数对出院时的每种常规用药达成共识，以此来评估不必要的药物使用情况。那些在适应证、疗效或治疗重复方面被评为不适当的药物被定义为不必要药物。
44%的患者至少有一种不必要药物，最常见的原因是缺乏适应证。最常被开具的不必要药物类别是胃肠道药物、中枢神经系统药物以及治疗用营养剂/矿物质。与不必要药物使用相关（P<0.05）的因素包括高血压（调整优势比[AOR]=0.61，95%置信区间[CI]=0.38 - 0.96）、多个开方者（AOR=3.35，95% CI=1.16 - 9.68）以及九种或更多药物（AOR=2.24，95% CI=1.25 - 3.99）。
在体弱的住院老年患者中，出院时不必要药物使用的患病率较高。需要进一步研究以确定非退伍军人人群中不必要药物使用的预测因素和患病率，从而设计干预措施来解决这一问题。
