Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.
Clin Pharmacol Ther. 2011 Jun;89(6):845-54. doi: 10.1038/clpt.2011.44. Epub 2011 Apr 20.
Inappropriate prescribing is particularly common in older patients and is associated with adverse drug events (ADEs), hospitalization, and wasteful utilization of resources. We randomized 400 hospitalized patients aged ≥ 65 years to receive either the usual pharmaceutical care (control) or screening with STOPP/START criteria followed up with recommendations to their attending physicians (intervention). The Medication Appropriateness Index (MAI) and Assessment of Underutilization (AOU) index were used to assess prescribing appropriateness, both at the time of discharge and for 6 months after discharge. Unnecessary polypharmacy, the use of drugs at incorrect doses, and potential drug-drug and drug-disease interactions were significantly lower in the intervention group at discharge (absolute risk reduction 35.7%, number needed to screen to yield improvement in MAI = 2.8 (95% confidence interval 2.2-3.8)). Underutilization of clinically indicated medications was also reduced (absolute risk reduction 21.2%, number needed to screen to yield reduction in AOU = 4.7 (95% confidence interval 3.4-7.5)). Significant improvements in prescribing appropriateness were sustained for 6 months after discharge.
不适当的处方在老年患者中尤为常见，并且与药物不良事件（ADE）、住院和资源浪费有关。我们随机选择了 400 名年龄≥65 岁的住院患者，将他们分为接受常规药物治疗（对照组）或使用 STOPP/START 标准进行筛查并将建议提供给主治医生（干预组）。在出院时和出院后 6 个月，使用药物适宜性指数（MAI）和未充分利用指数（AOU）来评估处方的适宜性。在出院时，干预组的不必要的多种药物治疗、药物剂量不正确使用以及潜在的药物-药物和药物-疾病相互作用显著减少（绝对风险降低 35.7%，需要筛查的人数以提高 MAI = 2.8（95%置信区间 2.2-3.8））。临床指征药物的未充分利用也减少（绝对风险降低 21.2%，需要筛查的人数以降低 AOU = 4.7（95%置信区间 3.4-7.5））。出院后 6 个月内，处方适宜性的显著改善得以维持。
