Cahir Caitriona, Bennett Kathleen, Teljeur Conor, Fahey Tom
Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, 8.
Br J Clin Pharmacol. 2014 Jan;77(1):201-10. doi: 10.1111/bcp.12161.
This study aimed to determine the association between potentially inappropriate prescribing (PIP) and health related outcomes [adverse drug events (ADEs), health related quality of life (HRQOL) and hospital accident and emergency (A&E) visits] in older community dwelling patients.
A retrospective cohort study of 931 community dwelling patients aged ≥70 years in 15 general practices in Ireland in 2010. PIP was defined by the Screening Tool of Older Person's Prescriptions (STOPP). ADEs were measured by patient self-report and medical record for the previous 6 months and reviewed by two independent clinicians. HRQOL was measured by the EQ-5D. A&E visits were measured by patients' medical records and self-report. Multilevel logistic, linear and Poisson regression examined how ADEs, HRQOL and A&E visits varied by PIP after adjusting for patient and practice level covariates: socioeconomic status, co-morbidity, number of drug classes and adherence.
The overall prevalence of PIP was 42% (n = 377). Patients with ≥2 PIP indicators were twice as likely to have an ADE (adjusted OR 2.21; 95% CI 1.02, 4.83, P < 0.05), have a significantly lower mean HRQOL utility (adjusted coefficient -0.09, SE 0.02, P < 0.001) and nearly a two-fold increased risk in the expected rate of A&E visits (adjusted IRR 1.85; 95% CI 1.32, 2.58, P < 0.001). The number of drug classes and adherence were also significantly associated with these same adverse health outcomes.
Reducing PIP in primary care may help lower the burden of ADEs, its associated health care use and costs and enhance quality of life in older patients.
本研究旨在确定老年社区居住患者中潜在不适当处方（PIP）与健康相关结局[药物不良事件（ADEs）、健康相关生活质量（HRQOL）和医院急诊（A&E）就诊]之间的关联。
对2010年爱尔兰15家全科诊所中931名年龄≥70岁的社区居住患者进行回顾性队列研究。PIP由老年人处方筛查工具（STOPP）定义。通过患者自我报告和前6个月的病历记录来衡量ADEs，并由两名独立的临床医生进行审核。HRQOL通过EQ-5D进行测量。A&E就诊通过患者的病历记录和自我报告来衡量。在调整患者和诊所层面的协变量（社会经济地位、合并症、药物类别数量和依从性）后，采用多水平逻辑回归、线性回归和泊松回归分析ADEs、HRQOL和A&E就诊如何因PIP而变化。
PIP的总体患病率为42%（n = 377）。有≥2个PIP指标的患者发生ADE的可能性是两倍（调整后的OR为2.21；95%CI为1.02，4.83，P < 0.05），平均HRQOL效用显著更低（调整系数为-0.09，SE为0.02，P < 0.001），A&E就诊预期率的风险几乎增加了两倍（调整后的IRR为1.85；95%CI为1.32，2.58，P < 0.001）。药物类别数量和依从性也与这些相同的不良健康结局显著相关。
减少初级保健中的PIP可能有助于降低ADEs的负担、其相关的医疗保健使用和成本，并提高老年患者的生活质量。
