HbL PharmaConsulting, St. Louis, MO, USA.
Ann Pharmacother. 2010 Dec;44(12):1968-75. doi: 10.1345/aph.1P426. Epub 2010 Nov 16.
To provide a comparative overview of explicit criteria that have been developed since 2003 for inappropriate prescribing in older adults and to contrast these newer criteria with the most recent Beers criteria, published in 2003.
MEDLINE and Google Scholar searches were performed from 2003 through July 2010. Within MEDLINE, MeSH terms included aged, drug prescriptions, medication errors, and polypharmacy. Free-text search terms included elderly, guideline adherence, inappropriate prescribing, and medications. Related articles, as identified by MEDLINE, were used as well. Free-text search was performed on Google Scholar, using "potentially inappropriate prescribing elderly." Additional articles were identified in reference lists of key articles.
Studies were selected if they were published after the most recent revision of the Beers criteria in 2003 and addressed the development and application of explicit criteria for the elderly. We independently reviewed pertinent literature to extract key information.
The first explicit criteria published were the Beers criteria, and most research regarding inappropriate medication use applied these criteria. Criteria developed subsequent to the Beers criteria include the French Consensus Panel list, STOPP (Screening Tool of Older Persons' Prescription) and START (Screening Tool to Alert doctors to Right Treatment), the Australian Prescribing Indicators tool, and the Norwegian General Practice Criteria. Newer criteria offer several improvements on the Beers criteria, namely drug-drug interactions, omission of potentially beneficial therapy, and more broadly applicable criteria across international borders.
Although no criteria may ever be globally applicable, STOPP and START make significant advances. Regional drug availability, economic considerations, and clinical practice patterns impact criteria selection. Research to validate the several newer criteria in various practice settings and to explore the effect of adhering to the guidelines on patient outcomes is warranted. Data from such research will aid practitioners in identifying preferred criteria.
提供自 2003 年以来制定的不适当处方老年患者的明确标准的比较概述，并将这些新标准与 2003 年发布的最新 Beers 标准进行对比。
从 2003 年到 2010 年 7 月，在 MEDLINE 和 Google Scholar 上进行了搜索。在 MEDLINE 中，MeSH 术语包括老年人、药物处方、药物错误和多种药物治疗。自由文本搜索词包括老年人、指南依从性、不适当处方和药物。还使用了 MEDLINE 确定的相关文章。在 Google Scholar 上进行了自由文本搜索，使用“老年人潜在不适当处方”。在关键文章的参考文献中也确定了其他文章。
如果研究是在 2003 年最新修订的 Beers 标准之后发表的，并且涉及明确的老年人标准的制定和应用，则选择这些研究。我们独立审查了相关文献以提取关键信息。
第一个明确的标准是 Beers 标准，并且大多数关于不适当药物使用的研究都应用了这些标准。在 Beers 标准之后制定的标准包括法国共识小组清单、STOPP（老年人处方筛选工具）和 START（筛选工具以提醒医生正确治疗）、澳大利亚处方指标工具和挪威全科医生标准。较新的标准在 Beers 标准上有几个改进，即药物相互作用、潜在有益治疗的遗漏以及更广泛适用于国际边界的标准。
虽然没有标准可能在全球范围内适用，但 STOPP 和 START 取得了重大进展。区域药物供应、经济考虑因素和临床实践模式影响标准选择。有必要在各种实践环境中验证几种新的标准并探索遵循指南对患者结局的影响的研究。此类研究的数据将有助于医生确定首选标准。
