Doubova Dubova Svetlana Vladislavovna, Reyes-Morales Hortensia, Torres-Arreola Laura del Pilar, Suárez-Ortega Magdalena
Epidemiology and Health Services Research Unit, National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico.
BMC Health Serv Res. 2007 Sep 19;7:147. doi: 10.1186/1472-6963-7-147.
In Mexico, inappropriate prescription of drugs with potential interactions causing serious risks to patient health has been little studied. Work in this area has focused mainly on hospitalized patients, with only specific drug combinations analyzed; moreover, the studies have not produced conclusive results. In the present study, we determined the frequency of potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age, who used Mexican Institute of Social Security (IMSS) family medicine clinics. In addition, we aimed to identify the associated factors for these interactions.
We collected information on general patient characteristics, medical histories, and medication (complete data). The study included 624 ambulatory patients over 50 years of age, with non-malignant pain syndrome, who made ambulatory visits to two IMSS family medicine clinics in Mexico City. The patients received 7-day prescriptions for non-opioid analgesics. The potential interactions were identified by using the Thompson Micromedex program. Data were analyzed using descriptive, bivariate and multiple logistic regression analyses.
The average number of prescribed drugs was 5.9 +/- 2.5. About 80.0% of patients had prescriptions implying one or more potential drug-drug interactions and 3.8% of patients were prescribed drug combinations with interactions that should be avoided. Also, 64.0% of patients had prescriptions implying one or more potential drug disease interactions. The factors significantly associated with having one or more potential interactions included: taking 5 or more medicines (adjusted Odds Ratio (OR): 4.34, 95%CI: 2.76-6.83), patient age 60 years or older (adjusted OR: 1.66, 95% CI: 1.01-2.74) and suffering from cardiovascular diseases (adjusted OR: 7.26, 95% CI: 4.61-11.44).
The high frequency of prescription of drugs with potential drug interactions showed in this study suggests that it is common practice in primary care level. To lower the frequency of potential interactions it could be necessary to make a careful selection of therapeutic alternatives, and in cases without other options, patients should be continuously monitored to identify adverse events.
在墨西哥，对具有潜在相互作用、可能给患者健康带来严重风险的药物的不当处方研究较少。该领域的工作主要集中在住院患者，仅分析了特定的药物组合；此外，研究并未得出确凿结果。在本研究中，我们确定了使用墨西哥社会保障局（IMSS）家庭医学诊所的50岁以上门诊患者处方中潜在药物-药物和药物-疾病相互作用的频率。此外，我们旨在确定这些相互作用的相关因素。
我们收集了患者的一般特征、病史和用药情况（完整数据）。该研究纳入了624名50岁以上患有非恶性疼痛综合征的门诊患者，他们在墨西哥城的两家IMSS家庭医学诊所进行门诊就诊。患者接受了为期7天的非阿片类镇痛药处方。使用汤普森Micromedex程序识别潜在的相互作用。采用描述性、双变量和多因素逻辑回归分析对数据进行分析。
平均处方药物数量为5.9±2.5。约80.0%的患者的处方存在一种或多种潜在药物-药物相互作用，3.8%的患者被开具了应避免相互作用的药物组合。此外，64.0%的患者的处方存在一种或多种潜在药物-疾病相互作用。与存在一种或多种潜在相互作用显著相关的因素包括：服用5种或更多药物（调整后的优势比（OR）：4.34，95%置信区间：2.76-6.83）、患者年龄60岁或以上（调整后的OR：1.66，95%置信区间：1.01-2.74）以及患有心血管疾病（调整后的OR：7.26，95%置信区间：4.61-11.44）。
本研究显示具有潜在药物相互作用的药物处方频率较高，这表明在初级保健层面这是常见做法。为降低潜在相互作用的频率，可能有必要仔细选择治疗方案，在没有其他选择的情况下，应对患者进行持续监测以识别不良事件。
