Barry P J, O'Keefe N, O'Connor K A, O'Mahony D
Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
J Clin Pharm Ther. 2006 Dec;31(6):617-26. doi: 10.1111/j.1365-2710.2006.00783.x.
In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions.
The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing.
A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +/- 6.1 years) and all patients had both Beers' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis.
The results of the study identified a high rate of inappropriate prescribing among this population of community-dwelling subjects. The total number of inappropriate prescriptions identified using the Beers' criteria (ID) was 148 affecting 121 patients. The Beers' criteria (CD) identified 69 inappropriate prescriptions in 60 patients and the IPET identified 112 inappropriate prescriptions in 78 patients. The Beers criteria (ID and CD combined) identified at least one inappropriate prescription in 34% of subjects and the IPET identified one in at least 22% of subjects.
This study identifies high rates of use of inappropriate medications in community-dwelling elderly presenting with acute illness to hospital. These are comparable with inappropriate prescribing rates identified in previous studies. The revised Beers' criteria (2003) identified more inappropriate prescriptions than the IPET in this population of elders.
在医院和社区中，老年人用药不当都是一个严重且持续存在的问题，欧洲的几个国家以及美国都对此有所描述。爱尔兰共和国尚未对用药不当问题进行量化。识别用药不当最常用的标准是Beers标准（2003年版，包括独立于诊断的标准和考虑诊断的标准）。Beers独立于诊断的标准包含48种不同类别的单一药物或同类多种药物，被认定为不适当处方；Beers考虑诊断的标准包含19种不同类别，涉及可能的药物 - 疾病相互作用。另一种工具，即老年人用药改进工具（IPET）也已得到验证，并用于医院和社区研究，它有14类明确禁忌的药物或可能的药物 - 疾病相互作用。
本研究的主要目的是测量爱尔兰共和国一家急症医院中前来就诊的社区老年个体用药不当的发生率。因此，本研究的次要目的还包括比较上述两种工具在识别用药不当方面的效果。
在4个月的时间内进行了一项前瞻性、连续观察队列研究。研究地点是一家位于城市的大学医院急性老年医学评估单元。本研究中的受试者（n = 350）在入院时（平均年龄 = 80.3±6.1岁）被连续筛查，所有患者在入院时都将Beers独立于诊断的标准、Beers考虑诊断的标准以及IPET应用于其处方药清单，并与他们当前的有效医学诊断清单进行交叉对照。
研究结果表明，在这群社区居住的受试者中，用药不当的发生率很高。使用Beers独立于诊断的标准识别出的不适当处方总数为148份，涉及121名患者。Beers考虑诊断的标准在60名患者中识别出69份不适当处方，IPET在78名患者中识别出112份不适当处方。Beers标准（独立于诊断的标准和考虑诊断的标准合并）在34%的受试者中识别出至少一份不适当处方，IPET在至少22%的受试者中识别出一份不适当处方。
本研究发现，因急性病前往医院就诊的社区老年患者中，使用不当药物的比例很高。这些比例与先前研究中确定的用药不当率相当。在这群老年人中，修订后的Beers标准（2003年）识别出的不适当处方比IPET更多。
