意大利住院老年患者不适当用药处方的频率。
Frequency of inappropriate medication prescription in hospitalized elderly patients in Italy.
机构信息
Department of Experimental Medicine, Second University of Naples, Naples, Italy.
出版信息
PLoS One. 2013 Dec 12;8(12):e82359. doi: 10.1371/journal.pone.0082359. eCollection 2013.
BACKGROUND
Older people often need comprehensive treatment, including many medications, and polypharmacy is common. The aims of this cross-sectional investigation were to examine the potentially inappropriate medication during the hospitalization and to identify the factors that may influence such inappropriateness among elderly in Italy.
METHODS
A sample of 605 individuals aged 65 years and older admitted in non-academic public acute care hospitals was randomly selected. Prescription of inappropriate medications were evaluated during the period from the day of admission to a randomly preselected day (index day). Beers Criteria were used to evaluate appropriateness.
RESULTS
At least one potentially inappropriate medication prescription from the day of hospital admission to the index day has been observed in 188 patients (31.1%), and respectively 84.1% and 15.9% of them had received one or two inappropriate medications. A total of 15 medications was prescribed inappropriately to these 188 patients, for 215 times with a total of 1143 doses. The multivariate logistic regression analysis revealed that the significant predictors for having at least one potentially inappropriate medication prescription during the hospitalization were: patients having an elementary education level, a lower pre-admission performance-based measure of basic activities of daily living, having received an inappropriate drug before the hospitalization, a hospital stay in the general and in the specialties surgical wards, a longer length of hospital stay from the admission to the index day, and having received a higher number of drugs from the day of the hospital admission to the index day. The most prevalent inappropriate medications administered were ketorolac (27.4%), amiodarone (19.1%), and clonidine (11.2%).
CONCLUSIONS
This study supports the need for clinical guidelines implementation to assist physicians in choosing the most appropriate drugs for the elderly and for effective education of all physicians.
背景
老年人通常需要综合治疗，包括多种药物，并且联合用药很常见。本次横断面研究的目的是调查老年人住院期间潜在的不适当用药情况，并确定可能影响意大利老年人这种不适当用药的因素。
方法
随机选择了意大利非学术性公立急性护理医院的 605 名 65 岁及以上的个体作为样本。在从入院日到随机选定的某一天（索引日）期间，评估处方中潜在不适当的药物。使用 Beers 标准来评估药物的适当性。
结果
在 188 名患者（31.1%）中观察到至少有一种从入院日到索引日的潜在不适当药物处方，其中 84.1%和 15.9%的患者分别接受了一种或两种不适当药物。总共为这 188 名患者开出了 15 种不适当的药物，共 215 次，总剂量为 1143 次。多变量逻辑回归分析显示，在住院期间至少有一个潜在不适当药物处方的显著预测因素包括：患者具有小学教育水平、较低的入院前基本日常生活活动的表现性测量得分、在入院前接受了不适当的药物、在普通病房和外科病房住院、从入院到索引日的住院时间较长，以及从入院日到索引日接受的药物数量较高。最常见的不适当用药包括酮咯酸（27.4%）、胺碘酮（19.1%）和可乐定（11.2%）。
结论
这项研究支持实施临床指南的必要性，以帮助医生为老年人选择最合适的药物，并对所有医生进行有效的教育。
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