Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA 19017, USA.
J Clin Pharm Ther. 2011 Aug;36(4):468-80. doi: 10.1111/j.1365-2710.2010.01195.x. Epub 2010 Oct 19.
Increasing attention is being paid to inappropriate medication prescribing for the elderly. A growing body of studies have detected a prevalence of inappropriate prescribing ranging from 12% to 40% worldwide, including Regione Emilia-Romagna, Italy. To improve quality of prescribing, a multi-phase pilot project in the Local Health Unit (LHU) of Parma, Regione Emilia-Romagna, was established. This phase aimed to assess primary care physicians' knowledge of appropriate prescribing in elderly patients.
In total, 155 primary care physicians (51% of the total), convened by the LHU of Parma for an educational session, were asked to complete anonymously a 19-item paper survey. Knowledge of inappropriate medication use in the elderly was assessed using seven clinical vignettes based on the 2002 Beers Criteria. Topics tested included hypertension, osteoarthritis, arrhythmias, insomnia and depression. Data regarding physician's perceived barriers to appropriate prescribing for elderly patients were also collected. To evaluate the relationship between physician knowledge scores and physician characteristics, physicians were classified as having a 'low score' (three or below) or a 'high score' (six or more) with respect to their knowledge of prescribing for the elderly.
All physicians completed the survey. Most physicians (88%) felt confident in their ability to prescribe appropriate medications for the elderly. Thirty-nine physicians (25%) received a 'high score' compared to 26 (17%) who received a 'low score'. 'Lower score' respondents had been in practice for a longer time (P < 0·05) than 'higher score' respondents. Perceived barriers to appropriate prescribing included potential drug interactions (79% of respondents) and the large number of medications a patient is already taking (75%).
The study results show an unsatisfactory knowledge of appropriate prescribing among primary care physicians in the LHU of Parma, especially among older physicians. Educational strategies tailored to primary care physicians should be establish to enhance knowledge in this area and improve quality of prescribing.
越来越多的人关注老年人用药不当的问题。越来越多的研究表明，全球范围内有 12%至 40%的老年人存在用药不当的情况，意大利艾米利亚-罗马涅地区也不例外。为了提高处方质量，艾米利亚-罗马涅地区帕尔马地方卫生单位（LHU）开展了一个多阶段的试点项目。该阶段旨在评估初级保健医生对老年患者合理用药的知识。
帕尔马 LHU 召集了 155 名初级保健医生（占总数的 51%）参加了一个教育课程，他们匿名填写了一份 19 项的纸质调查问卷。使用基于 2002 年 Beers 标准的七个临床病例来评估老年人药物使用不当的知识。测试的主题包括高血压、骨关节炎、心律失常、失眠和抑郁症。还收集了医生认为适当为老年患者开处方的障碍的数据。为了评估医生知识得分与医生特征之间的关系，将医生根据其为老年人开处方的知识分为“低得分”（3 分或以下）或“高得分”（6 分或以上）。
所有医生都完成了调查。大多数医生（88%）对自己为老年人开适当药物的能力有信心。39 名医生（25%）获得高分，26 名医生（17%）获得低分。与高分组相比，低分组的受访者从业时间更长（P<0·05）。适当开处方的障碍包括潜在的药物相互作用（79%的受访者）和患者已服用的药物数量多（75%）。
研究结果表明，帕尔马 LHU 的初级保健医生在适当开处方方面的知识水平令人不满意，尤其是年长的医生。应制定针对初级保健医生的教育策略，以提高这方面的知识，改善处方质量。
