多重用药总是有害的吗？一项使用来自初级和二级医疗保健机构的关联电子健康记录的回顾性队列分析。
Is polypharmacy always hazardous? A retrospective cohort analysis using linked electronic health records from primary and secondary care.
作者信息
Payne Rupert A, Abel Gary A, Avery Anthony J, Mercer Stewart W, Roland Martin O
机构信息
Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK.
出版信息
Br J Clin Pharmacol. 2014 Jun;77(6):1073-82. doi: 10.1111/bcp.12292.
AIMS
Prescribing multiple medications is associated with various adverse outcomes, and polypharmacy is commonly considered suggestive of poor prescribing. Polypharmacy might thus be associated with unplanned hospitalization. We sought to test this assumption.
METHODS
Scottish primary care data for 180 815 adults with long-term clinical conditions and numbers of regular medications were linked to national hospital admissions data for the following year. Using logistic regression (age, gender and deprivation adjusted), we modelled the association of prescribing with unplanned admission for patients with different numbers of long-term conditions.
RESULTS
Admissions were more common in patients on multiple medications, but admission risk varied with the number of conditions. For patients with one condition, the odds ratio for unplanned admission for four to six medications was 1.25 (95% confidence interval 1.11-1.42) vs. one to three medications, and 3.42 (95% confidence interval 2.72-4.28) for ≥10 medications vs. one to three medications. However, this effect was greatly reduced for patients with multiple conditions; amongst patients with six or more conditions, those on four to six medications were no more likely to have unplanned admissions than those taking one to three medications (odds ratio 1.00; 95% confidence interval 0.88-1.14), and those taking ≥10 medications had a modestly increased risk of admission (odds ratio 1.50; 95% confidence interval 1.31-1.71).
CONCLUSIONS
Unplanned hospitalization is strongly associated with the number of regular medications. However, the effect is reduced in patients with multiple conditions, in whom only the most extreme levels of polypharmacy are associated with increased admissions. Assumptions that polypharmacy is always hazardous and represents poor care should be tempered by clinical assessment of the conditions for which those drugs are being prescribed.
目的
开具多种药物与各种不良后果相关，多药联合使用通常被认为提示处方不当。因此，多药联合使用可能与非计划住院有关。我们试图验证这一假设。
方法
将180815名患有长期临床疾病且有常规用药数量的苏格兰初级保健数据与次年的国家医院入院数据相关联。使用逻辑回归（校正年龄、性别和贫困程度），我们对不同数量长期疾病患者的处方与非计划入院之间的关联进行建模。
结果
使用多种药物的患者入院更为常见，但入院风险因疾病数量而异。对于患有一种疾病的患者，使用四至六种药物的非计划入院比值比为1.25（95%置信区间1.11 - 1.42），而使用一至三种药物的为1；使用≥10种药物的与使用一至三种药物相比，比值比为3.42（95%置信区间2.72 - 4.28）。然而，对于患有多种疾病的患者，这种影响大大降低；在患有六种或更多疾病的患者中，使用四至六种药物的患者与使用一至三种药物的患者相比，非计划入院的可能性并无差异（比值比1.00；95%置信区间0.88 - 1.14），而使用≥10种药物的患者入院风险略有增加（比值比1.50；95%置信区间1.31 - 1.71）。
结论
非计划住院与常规用药数量密切相关。然而，在患有多种疾病的患者中，这种影响会降低，只有最极端的多药联合使用水平才与入院增加有关。关于多药联合使用总是有害且代表护理不佳的假设，应通过对开具这些药物所针对疾病的临床评估来加以缓和。
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