Vanderbilt University School of Nursing, Nashville, TN, USA.
Geriatr Nurs. 2011 Sep-Oct;32(5):350-6. doi: 10.1016/j.gerinurse.2011.07.003.
Previous studies have concluded that inappropriate medications and/or too many medications can lead to adverse events in older adults. The Beers List of potentially inappropriate medications (PIMs) for use in the elderly was developed to help guide clinicians to safely prescribe medications. Moreover, in the United States, policies exist regulating the number of prescriptions nursing home residents may take. Few studies have compared family and geriatric providers' prescribing trends. The aim of this study was to compare prescribing by family and geriatric providers in a rural U.S. nursing home using a nonequivalent 2-group analysis design with data collected via retrospective chart audits (N=92). Nursing home residents in the nongeriatric provider group had fewer total comorbidities (U=p<.001) and were less likely to have congestive heart failure (χ2=p<.001), coronary artery disease (χ2=p<.001), and degenerative joint disease (χ2=p<.001). Despite this, on average, providers who were not geriatric trained prescribed twice as many drugs per patient (U=p<.001). The odds were significantly greater of being prescribed 9 or more drugs (odds ratio 13.15, 95% confidence interval 4.3-39.5) or being prescribed at least 1 PIM (odds ratio 6.25, 95% confidence interval 1.3-29.0) if the prescriber was not geriatric trained. The prevalence in this nursing home of receiving at least 1 PIM and polypharmacy were 36.9% and 72.8%, respectively. Promethazine accounted for 46.9% of all PIMs prescribed. Geriatric education appears to have influenced prescribing patterns at this facility, with geriatric-trained providers adhering more closely to evidence-based guidelines for older patients. As geriatric educational content is incorporated into nongeriatric specialty areas, pharmacology and prescribing competencies should be an area of ongoing focus for educators.
先前的研究已经得出结论，不适当的药物和/或过多的药物会导致老年人出现不良事件。为了帮助临床医生安全地开具药物，开发了用于老年人的潜在不适当药物（PIM）的 Beers 清单。此外，在美国，存在规定养老院居民可开处方数量的政策。很少有研究比较家庭和老年科医生的开方趋势。本研究的目的是使用非等效 2 组分析设计并通过回顾性图表审查收集数据（N=92），比较美国农村养老院中家庭和老年科医生的开方情况。非老年科医生组的养老院居民总合并症较少（U=p<.001），充血性心力衰竭（χ2=p<.001）、冠状动脉疾病（χ2=p<.001）和退行性关节病（χ2=p<.001）的可能性较低。尽管如此，平均而言，未经老年科培训的医生为每位患者开出的药物数量是其两倍（U=p<.001）。如果医生未经老年科培训，被开 9 种或更多药物的可能性（比值比 13.15，95%置信区间 4.3-39.5）或开出至少 1 种 PIM 的可能性（比值比 6.25，95%置信区间 1.3-29.0）显著增加。该养老院接受至少 1 种 PIM 和多药治疗的患病率分别为 36.9%和 72.8%。异丙嗪占所有开出的 PIM 的 46.9%。老年教育似乎对该机构的开方模式产生了影响，接受过老年科培训的医生更严格地遵守针对老年患者的循证指南。随着老年教育内容纳入非老年专科领域，药理学和处方能力应成为教育者持续关注的领域。
