爱尔兰初级保健中老年人群中潜在不适当的处方。
Potentially inappropriate prescribing in an Irish elderly population in primary care.
机构信息
School of Pharmacy, University College Cork, Ireland.
出版信息
Br J Clin Pharmacol. 2009 Dec;68(6):936-47. doi: 10.1111/j.1365-2125.2009.03531.x.
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
- Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers' criteria, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.
WHAT THIS STUDY ADDS
- Potential errors of prescribing and of omission of medicines are prevalent among medically stable older people in primary care. * Screening tools should be incorporated into the everyday practice of primary care doctors and community pharmacists as a means of preventing potential errors of prescribing commission and prescribing omission in older people.
AIMS
Screening tools have been formulated to identify potentially inappropriate prescribing (IP) in older people. Beers' criteria are the most widely used but have disadvantages when used in Europe. New IP screening tools called Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) have been developed to identify potential IP and potential prescribing omissions (PPOs). The aim was to measure the prevalence rates of potential IP and PPOs in primary care using Beers' criteria, STOPP and START.
METHODS
Case records of 1329 patients >or=65 years old from three general practices in one region of southern Ireland were studied. The mean age +/- SD of the patients was 74.9 +/- 6.4 years, 60.9% were female. Patients' current diagnoses and prescription medicines were reviewed and the Beers' criteria, STOPP and START tools applied.
RESULTS
The total number of medicines prescribed was 6684; median number of medicines per patient was five (range 1-19). Overall, Beers' criteria identified 286 potentially inappropriate prescriptions in 18.3% (243) of patients, whilst the corresponding IP rate identified by STOPP was 21.4% (284), in respect of 346 potentially inappropriate prescriptions. A total of 333 PPOs were identified in 22.7% (302) of patients using the START tool.
CONCLUSION
Potentially inappropriate drug prescribing and errors of drug omission are highly prevalent among older people living in the community. Prevention strategies should involve primary care doctors and community pharmacists.
已知信息：老年人潜在不适当处方是一个有据可查的问题，与药物不良反应和住院有关。Beers 标准、老年人潜在不适当处方筛选工具（STOPP）和提醒医生正确治疗的筛选工具（START）是帮助医生和药剂师识别潜在不适当处方和潜在处方遗漏的筛选工具。根据 STOPP 和 START 标准，患有急性疾病的老年人群中潜在不适当处方和处方遗漏的发生率很高。
新发现：在初级保健中，稳定的老年人中普遍存在潜在的药物处方和漏用错误。筛选工具应纳入初级保健医生和社区药剂师的日常实践中，作为预防老年人潜在处方错误和处方遗漏的一种手段。
目的
筛选工具是为了识别老年人潜在的不适当处方（IP）而制定的。Beers 标准是最常用的标准，但在欧洲使用时存在缺点。新的 IP 筛选工具，即老年人处方筛选工具（STOPP）和提醒医生正确治疗的筛选工具（START），已被开发出来，以识别潜在的 IP 和潜在的处方遗漏（PPO）。目的是使用 Beers 标准、STOPP 和 START 来衡量初级保健中潜在 IP 和 PPO 的患病率。
方法
研究了爱尔兰南部一个地区的三个全科医生诊所的 1329 名年龄大于或等于 65 岁的患者的病历。患者的平均年龄 +/- SD 为 74.9 +/- 6.4 岁，60.9%为女性。对患者的当前诊断和处方药物进行了审查，并应用了 Beers 标准、STOPP 和 START 工具。
结果
共开具了 6684 种药物；每名患者的中位数药物数为 5 种（范围 1-19 种）。总体而言，Beers 标准在 18.3%（243 人）的患者中发现了 286 种潜在不适当处方，而 STOPP 标准发现的相应 IP 率为 21.4%（284 人），涉及 346 种潜在不适当处方。使用 START 工具共发现 333 种 PPO，在 22.7%（302 人）的患者中。
结论
社区中生活的老年人中潜在的药物治疗不当和药物遗漏错误非常普遍。预防策略应涉及初级保健医生和社区药剂师。
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