Popović Branislava, Quadranti Nives Radošević, Matanović Suzana Mimica, Lisica Ines Diminić, Ljubotina Aleksandar, Duliba Dubravka Pezelj, Vlahović-Palčevski Vera
Department of Family Medicine, University of Rijeka Medical Faculty, Braće Branchetta 20, 51000, Rijeka, Croatia.
Eur J Clin Pharmacol. 2014 Jun;70(6):737-44. doi: 10.1007/s00228-014-1667-0. Epub 2014 Mar 21.
The purpose of this study was to determine the prevalence of inappropriate prescribing to the elderly and to identify possible gender-related differences in prescribing certain potentially inappropriate medications (PIMs) to outpatients by using large administrative prescription database.
Medications prescribed for elderly outpatients (≥ 65 years) in Primorsko-Goranska County, Croatia, who received five or more different drugs simultaneously in 2010, were analyzed. The prevalence of potentially inappropriate drugs prescribed to the elderly was assessed using the new comprehensive protocol developed by authors Mimica Matanović and Vlahović-Palčevski.
A total of 62.4 % of patients received at least one medication with unfavorable benefit/risk ratio in the elderly. Female patients were given inappropriate medications in a significantly higher percentage than men (69.3 % vs. 50.5 %; p < 0.001). The average number of prescriptions for PIMs that should have been avoided with certain diseases or conditions was 0.88 per patient in the survey. The most common drug combination potentially leading to serious drug-drug interactions (DDIs) included an angiotensin-converting enzyme (ACE) inhibitor and a potassium supplement.
Our study has shown that every tenth medication prescribed to a patient > 65 years and receiving five or more drugs was potentially inappropriate. Elderly women were prescribed PIMs more often than men. Drugs of concern in female patients were benzodiazepines, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs). In male patients, there was a significantly higher proportion of possible interactions with warfarin, theophylline, and medications affecting the cardiovascular system, such as ACE inhibitors and amiodarone.
本研究旨在通过使用大型行政处方数据库，确定老年患者不适当处方的患病率，并识别在为门诊患者开具某些潜在不适当药物（PIMs）时可能存在的性别差异。
对克罗地亚滨海和戈尔什科兰斯卡县2010年同时接受五种或更多不同药物治疗的老年门诊患者（≥65岁）所开的药物进行分析。使用作者米米察·马塔诺维奇和弗拉霍维奇-帕尔切夫斯基制定的新综合方案评估老年患者潜在不适当药物的患病率。
共有62.4%的患者接受了至少一种对老年人有不利效益/风险比的药物。女性患者接受不适当药物的比例明显高于男性（69.3%对50.5%；p<0.001）。在调查中，因某些疾病或状况应避免使用的PIMs的平均处方数为每位患者0.88。最常见的可能导致严重药物相互作用（DDIs）的药物组合包括血管紧张素转换酶（ACE）抑制剂和钾补充剂。
我们的研究表明，在为65岁以上且接受五种或更多药物治疗的患者开具的每十份处方中，就有一份可能是不适当的。老年女性比男性更常被开具PIMs。女性患者中令人担忧的药物是苯二氮䓬类药物、抗抑郁药和非甾体抗炎药（NSAIDs）。在男性患者中，与华法林、茶碱以及影响心血管系统的药物（如ACE抑制剂和胺碘酮）发生相互作用的比例明显更高。
