Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA.
J Clin Pharm Ther. 2010 Apr;35(2):219-29. doi: 10.1111/j.1365-2710.2009.01094.x.
Inappropriate prescribing in the elderly population is a well-recognized problem in public health. The Beers criteria have been widely used to evaluate the quality of prescribing for the elderly. However, because the Beers criteria were developed in the United States, they are not fully applicable in Italy. The purpose of this study was to establish explicit criteria for potentially inappropriate medication prescribing (PIP) for the elderly and assess the prevalence of and factors associated with PIP among elderly residents in the Local Health Unit of Parma, Italy according to the developed criteria.
A nine-member expert panel was convened to identify a list of inappropriate medications reflecting the Italian prescribing habits. The panel decided to refine and update the 2002 Beers criteria. Consensus through a Nominal Group Technique was reached to classify the identified 23 inappropriate medications into three categories: 17 medications to be always avoided, three medications rarely appropriate, and three medications with some indications but often misused. A retrospective cohort study using the 2006 Parma Local Health Unit automated outpatient prescriptions database was conducted. The cohort comprised 91 741 elderly individuals >or=65 years with at least one prescription medication. PIP was defined as having a prescription claim for at least one inappropriate medication.
A total of 23 662 elderly in the cohort (25.8%) had at least one PIP. Of these, 14.1% received prescriptions for two medications of concern, and 2.0% for three or more. Using the expert panel's categories, 59.2% of the elderly receiving PIP had prescriptions for drugs that should always be avoided, 33.9% for rarely appropriate drugs, and 19.1% for drugs that have some indications but are often misused. Non-steroidal anti-inflammatory drugs (35.7% of subjects) were the most frequently occurring PIP, followed by ticlopidine (17.6%), doxazosin (15.5%), and amiodarone (13.6%). Female, older age, overall number of drugs prescribed, greater number of chronic conditions were factors associated with greater odds of receiving PIP.
Via the developed criteria, the study corroborates that PIP among elderly outpatients is a substantial issue in Parma Local Health Unit, Italy. Knowledge of the prevalence of PIP and associated factors should gear efforts to develop strategies to reduce PIP in outpatient settings in Italy.
老年人中不适当的处方用药是公共卫生领域公认的问题。Beers 标准被广泛用于评估老年人的处方质量。然而，由于 Beers 标准是在美国制定的，因此在意大利并不完全适用。本研究的目的是根据制定的标准，为意大利帕尔马地方卫生单位的老年人确定潜在不适当药物处方（PIP）的明确标准，并评估根据该标准老年人 PIP 的发生率和相关因素。
召集了一个由九名专家组成的小组，以确定反映意大利处方习惯的一组不适当药物。该小组决定改进和更新 2002 年 Beers 标准。通过名义小组技术达成共识，将确定的 23 种不适当药物分为三类：17 种药物应始终避免使用，3 种药物很少适当，3 种药物有一些适应症但经常被滥用。使用 2006 年帕尔马地方卫生单位自动门诊处方数据库进行回顾性队列研究。队列包括 91741 名年龄≥65 岁的至少有一份处方药物的老年人。PIP 定义为至少有一种不适当药物的处方。
在队列中共有 23662 名老年人（25.8%）至少有一种 PIP。其中，14.1%的人同时服用两种有问题的药物，2.0%的人同时服用三种或更多种药物。使用专家小组的分类，59.2%接受 PIP 的老年人的处方是为应始终避免使用的药物，33.9%为很少适当的药物，19.1%为有一些适应症但经常被滥用的药物。非甾体抗炎药（35.7%的患者）是最常见的 PIP，其次是噻氯匹定（17.6%）、多沙唑嗪（15.5%）和胺碘酮（13.6%）。女性、年龄较大、处方药物总数较多、患有更多慢性疾病是接受 PIP 的可能性更大的相关因素。
通过制定的标准，该研究证实了意大利帕尔马地方卫生单位老年门诊患者 PIP 是一个严重的问题。了解 PIP 的发生率和相关因素应有助于制定策略，以减少意大利门诊环境中的 PIP。
