Mansur Nariman, Weiss Avraham, Beloosesky Yichayaou
Pharmacy Services, Rabin Medical Center, Campus Beilinson, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel.
Ann Pharmacother. 2009 Feb;43(2):177-84. doi: 10.1345/aph.1L461. Epub 2009 Feb 3.
Inappropriate prescription drug (IPD) use is very common among older patients. However, its impact on medication continuity and adherence after hospitalization has not been researched, with little known regarding readmissions and mortality.
To investigate the prevalence and clinical characteristics of patients discharged with IPDs and examine whether use of these drugs is related to medication continuity and adherence 1 month postdischarge as well as to readmissions and mortality 3 months postdischarge.
Clinical and demographic data, postdischarge medication modification, and adherence were prospectively obtained on interview of 212 unselected elderly (aged > or = 65 y) patients or, if necessary, their caregivers. Nonadherence was defined as the percentage of drug doses less than or equal to 70% or greater than or equal to 110%. Medication appropriateness was assessed retrospectively using the Beers' criteria.
Use of IPDs occurred in 43.5% and 44.4% of patients on admission and discharge, respectively. At discharge, the numbers of IPDs and prescribed drugs were correlated (R = 0.39; p < 0.01). No relationship was found between IPDs at discharge and age, sex, functional and cognitive status, number of chronic diseases, and reason for admission. Sixty percent of patients who were nonadherent to at least one drug had at least one IPD, compared with 37.4% of the adherent patients (p = 0.008). Nonadherence to at least one drug increased as the number of IPDs on discharge increased (p = 0.004). No relationship was found between IPD use and postdischarge medication modifications, readmissions, and mortality.
A high number of hospitalized elderly patients are discharged with IPDs that are directly correlated with the number of prescribed drugs at discharge and postdischarge nonadherence. Further studies are needed to assess the impact of postdischarge IPD use on health outcome, and healthcare providers should work to decrease its prevalence.
不适当的处方药（IPD）使用在老年患者中非常普遍。然而，其对住院后药物治疗连续性和依从性的影响尚未得到研究，对于再入院率和死亡率也知之甚少。
调查出院时使用IPD的患者的患病率和临床特征，并检查这些药物的使用是否与出院后1个月的药物治疗连续性和依从性以及出院后3个月的再入院率和死亡率相关。
通过对212名未经过挑选的老年（年龄≥65岁）患者或必要时对其护理人员进行访谈，前瞻性地获取临床和人口统计学数据、出院后药物调整情况以及依从性。不依从定义为药物剂量低于或等于70%或高于或等于110%的百分比。使用Beers标准对药物使用的适当性进行回顾性评估。
入院时和出院时分别有43.5%和44.4%的患者使用IPD。出院时，IPD的数量与处方药数量相关（R = 0.39；p < 0.01）。未发现出院时的IPD与年龄、性别、功能和认知状态、慢性病数量以及入院原因之间存在关联。至少有一种药物不依从的患者中有60%至少有一种IPD，而依从患者中这一比例为37.4%（p = 0.008）。随着出院时IPD数量的增加，至少有一种药物不依从的情况增多（p = 0.004）。未发现IPD使用与出院后药物调整、再入院率和死亡率之间存在关联。
大量住院老年患者出院时使用IPD，这与出院时处方药数量和出院后不依从直接相关。需要进一步研究来评估出院后使用IPD对健康结局的影响，医疗服务提供者应努力降低其患病率。
