Page Robert L, Ruscin J Mark
Department of Clinical Pharmacy, University of Colorado Health Sciences Center, School of Pharmacy, Denver, Colorado 80262, USA.
Am J Geriatr Pharmacother. 2006 Dec;4(4):297-305. doi: 10.1016/j.amjopharm.2006.12.008.
Inappropriate medication prescribing is a significant problem among older adults that may contribute to increased morbidity and mortality as well as increased costs of care. The development of specific lists of medications that are considered potentially inappropriate for older adults, such as the Beers criteria (BC), make it relatively easy to study prescribing practices in large numbers of patients.
The goal of this study was to determine how frequently adverse drug events (ADEs) in the acute care setting are related to BC medications and to determine if BC medication prescribing is significantly associated with the occurrence of ADEs and other negative outcomes in older hospitalized adults.
This was a retrospective review of patients aged > or =75 years admitted to 2 adult internal medicine services over 18 months (March 2000-August 2001). Data regarding general demographic and clinical information were collected; this information included place of residence before admission and at discharge; medications at admission, during the hospital stay, and at discharge; ADEs; length of stay; and in-hospital mortality Patient medical records were used to determine the occurrence of ADEs.
: A total of 389 patients (68.9% female; mean age, approximately 79 years) were included. Of these 389 eligible patients, 107 (27.5%) were prescribed a total of 116 BC medications, and 124 (31.9%) experienced a total of 131 ADEs. Only 9.2% (12/131) of the ADEs were attributed to medications listed among the BC. After controlling for covariates, prescription of a BC medication was not significantly associated with experiencing an ADE (adjusted odds ratio [OR], 1.51; 95% CI, 0.98-2.35; P = 0.064), length of stay (adjusted OR, 1.03; 95% CI, 0.64-1.63; P = 0.91), discharge to higher levels of care (adjusted OR, 1.39; 95% CI, 0.82-2.34; P = 0.22), or in-hospital mortality (adjusted OR, 1.49; 95% CI, 0.77-2.92; P = 0.24).
Interventions targeted specifically at BC medications would have seemingly done little to change the risk of ADEs in this population. Interventions that are more comprehensive than the BC are necessary to reduce the risk of ADEs and the associated morbidity and mortality in acute care of the elderly.
不恰当的药物处方在老年人中是一个重大问题，可能导致发病率和死亡率上升以及护理成本增加。制定被认为可能不适用于老年人的特定药物清单，如《比尔斯标准》（BC），使得研究大量患者的处方行为相对容易。
本研究的目的是确定急性护理环境中药物不良事件（ADEs）与BC药物相关的频率，并确定BC药物处方是否与老年住院患者中ADEs的发生及其他负面结果显著相关。
这是一项对18个月内（2000年3月至2001年8月）入住两个成人内科科室的年龄≥75岁患者的回顾性研究。收集了一般人口统计学和临床信息数据；这些信息包括入院前和出院时的居住地点；入院时、住院期间和出院时的用药情况；ADEs；住院时间；以及院内死亡率。使用患者病历确定ADEs的发生情况。
共纳入389例患者（女性占68.9%；平均年龄约79岁）。在这389例符合条件的患者中，107例（27.5%）共开具了116种BC药物，124例（31.9%）共经历了131次ADEs。ADEs中仅有9.2%（12/131）归因于BC清单中的药物。在对协变量进行控制后，BC药物的处方与发生ADEs（调整后的优势比[OR]为1.51；95%可信区间[CI]为0.98 - 2.35；P = 0.064）、住院时间（调整后的OR为1.03；95%CI为0.64 - 1.63；P = 0.91）、转至更高护理级别（调整后的OR为1.39；95%CI为0.82 - 2.34；P = 0.22）或院内死亡率（调整后的OR为1.49；95%CI为0.77 - 2.92；P = 0.24）均无显著关联。
专门针对BC药物的干预措施似乎对改变该人群中ADEs的风险作用不大。需要比BC更全面的干预措施来降低老年人急性护理中ADEs的风险以及相关的发病率和死亡率。
