Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2012;7(8):e43617. doi: 10.1371/journal.pone.0043617. Epub 2012 Aug 22.
Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting.
The aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting.
We systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class.
We included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52 (0.10-23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30 (0.02-4.40)% and amitriptiline 3.20 (0.05-20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription.
Approximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events. These medications are good candidates for being targeted for improvement e.g. by computerized clinical decision support.
在初级保健环境中，不适当的药物处方是导致老年人可预防药物不良事件的常见原因。
本系统评价的目的是量化初级保健环境中老年人处方不适当的程度。
我们系统地检索了 Ovid-Medline 和 Ovid-EMBASE，分别从 1950 年和 1980 年检索到 2012 年 3 月。两位独立的审查员筛选并选择了发表在英文期刊上的、针对初级保健环境中老年人（>65 岁）药物处方不适当的原始研究。我们提取了数据源、评估药物处方适当性的工具以及不适当药物处方的比率。我们根据解剖治疗化学（ATC）分类对报告的个别药物进行分组，并比较了每个治疗类别中不适当药物处方的中位数及其范围。
我们纳入了 19 项研究，其中 14 项研究使用 Beers 标准作为评估处方适当性的工具。不适当药物处方的中位数比率（IMP）为 20.5%[IQR 18.1 至 25.6%]。药物中 IMP 中位数比率最高的是丙氧芬 4.52（0.10-23.30）%、多沙唑嗪 3.96（0.32-15.70）%、苯海拉明 3.30（0.02-4.40）%和阿米替林 3.20（0.05-20.5）%，按 IMP 比率降序排列。现有研究描述了不相等的药物集和不同的测量工具，以估计总体不适当处方的发生率。
尽管已经关注处方质量，但初级保健中仍有大约五分之一的处方不适当。苯海拉明和阿米替林是最常见的不适当处方药物，具有高风险的不良事件，而丙氧芬和多沙唑嗪是最常见的低风险不良事件处方药物。这些药物是改善的良好候选药物，例如通过计算机临床决策支持。
