德国老年广泛性焦虑症患者潜在不适当处方的严重程度。

Magnitude of potentially inappropriate prescribing in Germany among older patients with generalized anxiety disorder.

机构信息

Policy Analysis, Inc, Brookline, USA.

出版信息

BMC Geriatr. 2009 Jul 27;9:31. doi: 10.1186/1471-2318-9-31.

DOI:10.1186/1471-2318-9-31

PMID:19635161

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2723114/

Abstract

BACKGROUND

Several medications commonly used to treat generalized anxiety disorder (GAD) have been designated "potentially inappropriate" for use in patients aged > or =65 years because their risks may outweigh their potential benefits. The actual extent of use of these agents in clinical practice is unknown, however.

METHODS

Using a database with information from encounters with general practitioners (GP) in Germany, we identified all patients, aged > or =65 years, with any GP office visits or dispensed prescriptions with a diagnosis of GAD (ICD-10 diagnosis code F41.1) between 10/1/2003 and 9/30/2004 ("GAD patients"). Among GAD-related medications (including benzodiazepines, tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors, venlafaxine, hydroxyzine, buspirone, pregabalin, and trifluoperazine), long-acting benzodiazepines, selected short-acting benzodiazepines at relatively high dosages, selected TCAs, and hydroxyzine were designated "potentially inappropriate" for use in patients aged > or = 65 years, based on published criteria.

RESULTS

A total of 975 elderly patients with GAD were identified. Mean age was 75 years, and 72% were women; 29% had diagnoses of comorbid depression. Forty percent of study subjects received potentially inappropriate agents - most commonly, bromazepam (10% of all subjects), diazepam (9%), doxepin (7%), amitriptyline (5%), and lorazepam (5%). Twenty-three percent of study subjects received long-acting benzodiazepines, 10% received short-acting benzodiazepines at relatively high doses, and 12% received TCAs designated as potentially inappropriate.

CONCLUSION

GPs in Germany often prescribe medications that have been designated as potentially inappropriate to their elderly patients with GAD - especially those with comorbid depressive disorders. Further research is needed to ascertain whether there are specific subgoups of elderly patients with GAD for whom the benefits of these medications outweigh their risks.

摘要

背景

有几种常用于治疗广泛性焦虑症（GAD）的药物已被指定为不适合年龄≥65 岁的患者使用，因为它们的风险可能超过潜在益处。然而，这些药物在临床实践中的实际使用情况尚不清楚。

方法

我们使用一个包含德国全科医生就诊信息的数据库，确定了所有在 2003 年 10 月 1 日至 2004 年 9 月 30 日期间因 GAD（ICD-10 诊断代码 F41.1）接受任何全科医生就诊或配药的年龄≥65 岁的患者（GAD 患者）。在 GAD 相关药物（包括苯二氮䓬类、三环抗抑郁药[TCAs]、选择性 5-羟色胺再摄取抑制剂、文拉法辛、羟嗪、丁螺环酮、普瑞巴林和三氟拉嗪）中，长效苯二氮䓬类、相对高剂量的选定短效苯二氮䓬类、选定的 TCAs 和羟嗪被指定为年龄≥65 岁患者的潜在不适当用药，这是基于已发表的标准。

结果

共确定了 975 名患有 GAD 的老年患者。平均年龄为 75 岁，72%为女性；29%有合并抑郁的诊断。40%的研究对象接受了潜在不适当的药物治疗-最常见的是溴马唑仑（所有受试者的 10%）、地西泮（9%）、多塞平（7%）、阿米替林（5%）和劳拉西泮（5%）。23%的研究对象接受了长效苯二氮䓬类药物，10%接受了相对高剂量的短效苯二氮䓬类药物，12%接受了被指定为潜在不适当的 TCAs。