Haynes Kevin, Hennessy Sean, Localio A Russell, Cohen Abigail, Leonard Charles E, Kimmel Stephen E, Feldman Harold I, Strom Brian L, Metlay Joshua P
Program for the Reduction in Medication Errors, Department of Biostatistics and Epidemiology and School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6021, USA.
Pharmacoepidemiol Drug Saf. 2009 Jan;18(1):28-35. doi: 10.1002/pds.1680.
Adverse drug events (ADEs) are an important cause of preventable hospitalizations among elderly individuals taking high-risk medications. The objective of the study was to identify health care system factors that affect the risk of digoxin toxicity for older adults on digoxin.
We conducted a prospective cohort study of older adults within the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program, which provides comprehensive drug benefits for older adults with low income. Subjects were interviewed at the time of enrollment regarding the management and coordination of their health care as well as medication comprehension. Hospitalizations were identified by linking patient identifiers to a state-wide registry. Trained abstractors reviewed discharge summaries of possible digoxin related ADEs. Unadjusted and adjusted incidence rate ratios (IRR) were calculated based on person-months of exposure using Poisson regression models, with variances adjusted for within subject repeated measures.
We enrolled a total of 2030 adults on digoxin from May 2002 to June 2003. A total of 34 hospitalizations due to digoxin toxicity occurred, equivalent to 1.12 hospitalizations per 1000 person-months of exposure. Adjusting for hospitalization in the past 2 months, age, total number physicians prescribing any medications in past 3 months, total number of pharmacies filling medications in past 3 months, and number of unique prescriptions filled in the past month had a 4.25-fold increased risk of subsequently experiencing digoxin toxicity (IRR 95%CI 1.95, 9.27).
The risk of digoxin toxicity-related hospitalization, while low, is higher in the post-hospital period.
药物不良事件（ADEs）是服用高风险药物的老年人可预防住院的重要原因。本研究的目的是确定影响服用地高辛的老年人发生地高辛中毒风险的医疗保健系统因素。
我们对宾夕法尼亚州老年人药物援助合同（PACE）项目中的老年人进行了一项前瞻性队列研究，该项目为低收入老年人提供全面的药物福利。在入组时对受试者进行访谈，了解其医疗保健的管理与协调情况以及用药理解能力。通过将患者标识符与全州登记处进行关联来确定住院情况。经过培训的摘要员审查了可能与地高辛相关的药物不良事件的出院小结。使用泊松回归模型，基于暴露的人月数计算未调整和调整后的发病率比（IRR），并针对受试者内重复测量调整方差。
2002年5月至2003年6月，我们共招募了2030名服用地高辛的成年人。因地高辛中毒导致的住院共计34例，相当于每1000人月暴露中有1.12例住院。在调整了过去2个月内的住院情况、年龄、过去3个月内开具任何药物的医生总数、过去3个月内配药的药房总数以及过去1个月内开具的独特处方数量后，随后发生地高辛中毒的风险增加了4.25倍（IRR 95%CI 1.95，9.27）。
与地高辛中毒相关的住院风险虽低，但在出院后时期更高。
