Freund Jeff, Meiman Jon, Kraus Connie
University of Colorado, Aurora, CO, USA.
J Prim Care Community Health. 2013 Oct;4(4):286-93. doi: 10.1177/2150131913495243. Epub 2013 Jul 8.
Our primary aim was to characterize the level of medication use across age-groups by examining electronic medical record data for a large number of patients receiving care in primary care clinics. A secondary aim was to identify factors associated with higher levels of medication use or polypharmacy.
We conducted a retrospective query of electronic medical record data from a clinical data warehouse, evaluating 114 012 patients seen in primary care clinics at least once in the previous 6 months. Medication use was evaluated in 3 different categories: level 1 (0-4 medications), level 2 (5-9 medications), and level 3 (≥ 10 medications). Multivariate analysis was used to analyze different patient demographics and comorbidities for association with level of medication use.
At ages 18 to 24 years, 15% (male) to 23% (female) of patients were taking greater than 5 medications, a trend that continued to increase with older cohorts. Female patients were more likely to have level 2 (odds ratio [OR] = 1.76) and level 3 (OR = 2.73) use compared with men. Level 2 and level 3 use was associated with other patient characteristics, including number of patient encounters (level 2 OR = 2.99; level 3 OR = 8.08 for >7 encounters) and common chronic conditions such as chronic pain (level 2 OR = 2.56; level 3 OR = 6.40), diabetes (level 2 OR = 2.4; level 3 OR = 4.61), heart disease (level 2 OR = 1.99; level 3 OR = 3.65), hypertension (level 2 OR = 2.27; level 3 OR = 2.87), and dyslipidemia (level 2 OR = 1.82; level 3 OR = 2.12).
Electronic medical record data may be an important tool for providing more comprehensive information regarding medication usage. Medication usage assessed by electronic medical records, even among the youngest cohort, appears to be greater than other sources of medication usage indicate. Higher levels of medication use were associated with a number of factors, including gender, body mass index, number of patient encounters, and comorbid conditions.
我们的主要目标是通过检查初级保健诊所中大量接受治疗患者的电子病历数据，来描述各年龄组的用药水平。次要目标是确定与较高用药水平或多重用药相关的因素。
我们对临床数据仓库中的电子病历数据进行了回顾性查询，评估了在过去6个月中至少在初级保健诊所就诊过一次的114012名患者。用药情况在3个不同类别中进行评估：1级（0 - 4种药物）、2级（5 - 9种药物）和3级（≥10种药物）。采用多变量分析来分析不同患者人口统计学特征和合并症与用药水平的关联。
在18至24岁的患者中，15%（男性）至23%（女性）服用超过5种药物，这一趋势随着年龄增长的队列持续上升。与男性相比，女性患者更有可能处于2级（优势比[OR]=1.76）和3级（OR = 2.73）用药水平。2级和3级用药与其他患者特征相关，包括就诊次数（2级OR = 2.99；就诊次数>7次时，3级OR = 8.08）以及常见慢性病，如慢性疼痛（2级OR = 2.56；3级OR = 6.40）、糖尿病（2级OR = 2.4；3级OR = 4.61）、心脏病（2级OR = 1.99；3级OR = 3.65）、高血压（2级OR = 2.27；3级OR = 2.87）和血脂异常（2级OR = 1.82；3级OR = 2.12）。
电子病历数据可能是提供有关用药情况更全面信息的重要工具。通过电子病历评估的用药情况，即使在最年轻的队列中，似乎也高于其他用药情况来源所显示的水平。较高的用药水平与多种因素相关，包括性别、体重指数、就诊次数和合并症。
