Clinical and Practice Research Group, School of Pharmacy, Queen's University, Belfast, Belfast, Northern Ireland, UK.
J Eval Clin Pract. 2012 Dec;18(6):1196-202. doi: 10.1111/j.1365-2753.2011.01758.x. Epub 2011 Aug 24.
RATIONAL, AIMS AND OBJECTIVE: The aim of the present study was to compare the ease of use and the capability of four approaches [Medication Appropriateness Index (MAI), the Beers' criteria 2003, the Improved Prescribing in the Elderly Tool (IPET) and Health Plan Employer Data and Information Set (HEDIS)] in assessing changes in medication appropriateness in elderly patients over a period of hospitalization.
A retrospective observational study in two hospitals in Northern Ireland using the four measures was undertaken, involving a cohort of 192 patients (aged > 65 years). Medication appropriateness assessments were made at three stages during the patients' hospital 'journey', that is, at admission, during their inpatient stay and at discharge. The identifying rates of inappropriate prescribing in elderly patients in hospital used validated screening tools: MAI, the Beers' criteria 2003, the IPET and HEDIS.
The MAI was the most comprehensive approach but was also the most time consuming to apply. Data derived using the MAI indicated clearly that there was improved medication appropriateness over the three hospital stay stages (P < 0.001). Although this trend was also significant for the Beers' criteria 2003 (P < 0.05) and the IPET (P < 0.05) approaches, the HEDIS was unable to differentiate changes in appropriateness over time. There was a good correlation between data derived using the MAI and the Beers' criteria 2003 and the IPET approaches; this correlation was not evident for the HEDIS.
The MAI is the most convincing tool in evaluating medication appropriateness, but is very time consuming to apply. Beers' criteria 2003 and the IPET perform to an acceptable standard within the clinical setting and are more practical in their application. The HEDIS, although simplest to apply, does not have the sensitivity to measure change in appropriateness over time.
本研究旨在比较四种方法[药物适宜性指数（MAI）、2003 年 Beers 标准、老年人改进处方工具（IPET）和健康计划雇主数据和信息集（HEDIS）]在评估住院老年患者药物适宜性变化方面的易用性和能力。
在北爱尔兰的两家医院进行了一项回顾性观察研究，使用了上述四种方法，涉及 192 名（年龄>65 岁）患者。在患者住院期间的三个阶段进行药物适宜性评估，即入院时、住院期间和出院时。使用经过验证的筛选工具对住院老年患者的不适当处方进行识别率评估：MAI、2003 年 Beers 标准、IPET 和 HEDIS。
MAI 是最全面的方法，但应用起来也最耗时。使用 MAI 得出的数据清楚地表明，在三个住院阶段，药物适宜性有所改善（P<0.001）。虽然 2003 年 Beers 标准（P<0.05）和 IPET（P<0.05）方法也有这种趋势，但 HEDIS 无法区分随时间变化的适宜性。MAI 与 2003 年 Beers 标准和 IPET 方法得出的数据之间存在良好的相关性；而与 HEDIS 之间则不明显。
MAI 是评估药物适宜性最令人信服的工具，但应用起来非常耗时。2003 年 Beers 标准和 IPET 在临床环境中表现出可接受的标准，并且在应用方面更加实用。尽管 HEDIS 应用最简单，但它没有敏感性来衡量随时间变化的适宜性。
