Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
Eur J Clin Pharmacol. 2011 Nov;67(11):1175-88. doi: 10.1007/s00228-011-1061-0. Epub 2011 May 17.
Potentially inappropriate prescribing is common in older people presenting to hospital with acute illness in Ireland. The aim of this study was to determine if this phenomenon is unique to Ireland or whether it is a more widespread problem in hospitals across Europe.
Prospective data were collected from 900 consecutive older patients admitted to six university teaching hospitals (150 patients per centre) in Geneva (Switzerland), Madrid (Spain), Oostende (Belgium), Perugia (Italy), Prague (Czech Republic) and Cork (Ireland). Age, gender, comorbidity, cognitive status, prescription medicines taken before admission and baseline haematological, biochemical and electrocardiographic data were recorded. STOPP and Beers' criteria were applied to detect potentially inappropriate medicines (PIMs). START criteria were applied to detect potentially inappropriate prescribing omissions (PPOs).
The overall PIM prevalence rate was 51.3% using STOPP criteria, varying from 34.7% in Prague to 77.3% in Geneva, and 30.4% using Beer's criteria, varying from 22.7% in Prague to 43.3% in Geneva. Using START criteria, the overall PPO prevalence rate was 59.4%, ranging from 51.3% in Cork to 72.7% in Perugia. Polypharmacy predicted the presence of PIMs using STOPP criteria [with >10 medications: odds ratio (OR) 7.22, 95% confidence interval (CI) 4.30-12.12, p < 0.001] and Beers' criteria (with >10 medications: OR 4.87, 95% CI 3.00-7.90, p < 0.001). Increasing co-morbidity (Charlson Index ≥2) and age ≥85 years significantly predicted PPOs.
Potentially inappropriate drug prescribing and the omission of beneficial drugs are highly prevalent in acutely ill hospitalized older people in six European centres.
在爱尔兰，因急性疾病住院的老年人中，潜在不适当的处方用药很常见。本研究的目的是确定这种现象是否仅在爱尔兰存在，还是在欧洲其他医院更为普遍。
前瞻性数据收集自 900 名连续入住六所大学教学医院（每个中心 150 名患者）的老年患者（瑞士日内瓦、西班牙马德里、比利时奥斯坦德、意大利佩鲁贾、捷克布拉格和爱尔兰科克）。记录年龄、性别、合并症、认知状态、入院前服用的处方药物以及基线血液生化和心电图数据。应用 STOPP 和 Beers 标准来发现潜在不适当药物（PIMs）。应用 START 标准来发现潜在不适当的处方遗漏（PPOs）。
应用 STOPP 标准时，总体 PIM 患病率为 51.3%，范围为布拉格的 34.7%至日内瓦的 77.3%；应用 Beer 标准时，总体 PIM 患病率为 30.4%，范围为布拉格的 22.7%至日内瓦的 43.3%。应用 START 标准时，总体 PPO 患病率为 59.4%，范围为科克的 51.3%至佩鲁贾的 72.7%。多药治疗预测了 STOPP 标准下 PIMs 的存在[使用>10 种药物：比值比（OR）7.22，95%置信区间（CI）4.30-12.12，p<0.001]和 Beer 标准（使用>10 种药物：OR 4.87，95%CI 3.00-7.90，p<0.001）。合并症增多（Charlson 指数≥2）和年龄≥85 岁显著预测了 PPOs。
在六个欧洲中心的急性病住院老年患者中，潜在不适当的药物治疗和有益药物的遗漏非常普遍。
