Rossi Michelle I, Young Amanda, Maher Robert, Rodriguez Keri L, Appelt Cathleen J, Perera Subashan, Hajjar Emily R, Hanlon Joseph T
Geriatric Research, Education and Clinical Center, Pittsburgh VAMC, Pittsburgh, Pennsylvania 15213, USA.
Am J Geriatr Pharmacother. 2007 Dec;5(4):317-23. doi: 10.1016/j.amjopharm.2007.12.001.
Polypharmacy is a significant problem among older adults. Patient-related characteristics and beliefs have not been the focus of prior research in this area, which has primarily evaluated the effects of patients' health status and health care system factors.
The goal of this research was to determine the prevalence and predictors of unnecessary drug use in older veteran outpatients, with a focus on patient-related factors and health beliefs.
Community-dwelling veterans aged > or =60 years, with > or =5 self-administered medications per day, not cognitively impaired, able to speak and/or write English, and receiving primary care and medications from a large urban Veterans Affairs Medical Center were eligible for study. Assessment of unnecessary drug use was determined by clinical pharmacists applying the criteria of the Medication Appropriateness Index to each regularly scheduled medication. Those drugs that received an inappropriate rating for indication, effectiveness, or therapeutic duplication were defined as unnecessary. Health beliefs regarding medication use were assessed with decisional balance, self-efficacy, and health locus of control scales.
A total of 128 veterans (mean [SD] age, 72.0 [8.9] years; 93.0% white; 93.0% male) were enrolled. Analysis showed that 58.6% of patients had > or =1 unnecessary prescribed drug; the most common reason for a medication being considered inappropriate was lack of effectiveness (41.4%). The most commonly prescribed unnecessary drug classes were central nervous system (19.5%), gastrointestinal (18.0%), and vitamins (16.4%). Factors with tendency for association (P < 0.20) with any unnecessary drug use included race (white), income (<$30,000/year), number of prescription medications (mean [SD], 6.8 [2.8]), and lack of belief in a "powerful other" for their health locus of control.
We found a very high prevalence of unnecessary drug use in this older veteran outpatient population. Race, income, and polypharmacy, as well as health-related beliefs, were central factors associated with unnecessary drug use.
多重用药是老年人中的一个重要问题。患者相关特征和信念此前并非该领域研究的重点，此前研究主要评估患者健康状况和医疗保健系统因素的影响。
本研究的目的是确定老年退伍军人门诊患者中不必要药物使用的患病率及预测因素，重点关注患者相关因素和健康信念。
年龄≥60岁、每天自行服用≥5种药物、无认知障碍、能说和/或写英语、并在一家大型城市退伍军人事务医疗中心接受初级保健和药物治疗的社区居住退伍军人符合研究条件。临床药师根据用药适宜性指数标准对每种定期服用的药物进行评估，以确定不必要药物的使用情况。那些在适应证、有效性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。使用决策平衡、自我效能感和健康控制点量表评估有关药物使用的健康信念。
共纳入128名退伍军人（平均[标准差]年龄，72.0[8.9]岁；93.0%为白人；93.0%为男性）。分析表明，58.6%的患者有≥1种不必要的处方药；药物被认为不适当的最常见原因是缺乏有效性（41.4%）。最常被开具的不必要药物类别是中枢神经系统药物（19.5%）、胃肠道药物（18.0%）和维生素（16.4%）。与任何不必要药物使用有相关倾向（P<0.20）的因素包括种族（白人）、收入（<30,000美元/年）、处方药数量（平均[标准差]，6.8[2.8]）以及对其健康控制点缺乏“强大他人”信念。
我们发现该老年退伍军人门诊患者中不必要药物使用的患病率非常高。种族、收入、多重用药以及与健康相关的信念是与不必要药物使用相关的核心因素。
