Centro Medicina dell'Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italy.
J Gerontol A Biol Sci Med Sci. 2014 Apr;69(4):430-7. doi: 10.1093/gerona/glt118. Epub 2013 Aug 2.
Poor quality of drug prescribing in older persons is often associated with increased drug-related adverse events, hospitalization, and mortality. The present study describes a set of prescribing quality indicators developed by the Geriatrics Working Group of the Italian Medicines Agency (AIFA) and estimates their prevalence in the entire elderly (≥ 65 years) population in Italy.
We performed a cross-sectional study using 2011 data from the OsMed (Osservatorio dei Medicinali) database, which comprises all prescribed drugs that are reimbursed by the Italian National Healthcare System. Yearly prevalence of drug prescribing quality indicators in the Italian older population (n = 12,301,537) was determined.
Overall, 13 quality indicators addressing polypharmacy, adherence to treatment of chronic diseases, prescribing cascade, undertreatment, drug-drug interactions, and drugs to be avoided were identified. Polypharmacy was common, with more than 1.3 million individuals taking greater than or equal to 10 drugs (11.3% of the study population). The prevalence of low adherence and undertreatment was also elevated and increased with advancing age, with highest prevalence occurring in individuals aged 85 years and older. Prevalence was less than 3% for quality indicators assessing the prescribing cascade, drug-drug interactions, and drugs to be avoided.
These results confirm the high frequency of suboptimal drug prescribing in older adults, using a database that covers the whole Italian population. In general, this descriptive study may help in prioritizing strategies aimed at improving the quality of prescribing in elderly population.
老年人药物处方质量差通常与药物相关不良事件、住院和死亡风险增加有关。本研究描述了一组由意大利药品管理局（AIFA）老年病学工作组制定的药物处方质量指标，并估计了它们在意大利所有老年人（≥65 岁）人群中的流行程度。
我们使用 2011 年 OsMed（药物观察站）数据库进行了一项横断面研究，该数据库包含所有由意大利国家卫生保健系统报销的处方药物。确定了意大利老年人群（n=12,301,537）中药物处方质量指标的年患病率。
总体而言，确定了 13 个药物处方质量指标，涉及多种药物治疗、治疗慢性疾病的依从性、处方级联、治疗不足、药物相互作用和应避免的药物。多种药物治疗很常见，超过 130 万人服用≥10 种药物（占研究人群的 11.3%）。低依从性和治疗不足的患病率也很高，并随年龄增长而增加，85 岁及以上人群的患病率最高。评估处方级联、药物相互作用和应避免的药物的质量指标的患病率低于 3%。
这些结果证实了老年人药物处方质量差的高频率，使用了涵盖整个意大利人口的数据库。一般来说，这项描述性研究可以帮助确定优先策略，旨在改善老年人群的药物处方质量。
