Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.
BMC Fam Pract. 2014 Apr 2;15:59. doi: 10.1186/1471-2296-15-59.
Health care policy-makers look for prescribing indicators at the population level to evaluate the performance of prescribers, improve quality and control drug costs. The aim of this research was to; (i) estimate the level of variation in potentially inappropriate prescribing (PIP) across prescribers in the national Irish older population using the STOPP criteria; (ii) estimate how reliably the criteria could distinguish between prescribers in terms of their proportion of PIP and; (iii) examine how PIP varies between prescribers and by patient and prescriber characteristics in a multilevel regression model.
1,938 general practitioners (GPs) with 338,375 registered patients' ≥70 years were extracted from the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. HSE-PCRS prescriptions are WHO ATC coded. Demographic data for claimants' and prescribers' are available. Thirty STOPP indicators were applied to prescription claims in 2007. Multilevel logistic regression examined how PIP varied between prescribers and by individual patient and prescriber level variables.
The unadjusted variation in PIP between prescribers was considerable (median 35%, IQR 30-40%). The STOPP criteria were reliable measures of PIP (average >0.8 reliability). The multilevel regression models found that only the patient level variable, number of different repeat drug classes was strongly associated with PIP (>2 drugs v none; adjusted OR, 4.0; 95% CI 3.7, 4.3). After adjustment for patient level variables the proportion of PIP varied fourfold (0.5 to 2 times the expected proportion) between prescribers but the majority of this variation was not significant.
PIP is of concern for all prescribers. Interventions aimed at enhancing appropriateness of prescribing should target patients taking multiple medications.
医疗保健政策制定者在人群水平上寻找处方指标，以评估开处方者的绩效，提高质量并控制药物成本。本研究的目的是：（i）使用 STOPP 标准评估全国爱尔兰老年人群中潜在不适当处方（PIP）在开处方者之间的水平差异；（ii）评估标准在多大程度上可以可靠地区分开处方者的 PIP 比例；（iii）在多水平回归模型中检查 PIP 在开处方者之间以及患者和开处方者特征之间的变化。
从健康服务执行局初级保健报销服务（HSE-PCRS）药房报销数据库中提取了 1938 名全科医生（GP）和 338375 名≥70 岁的登记患者。HSE-PCRS 处方是按照世界卫生组织 ATC 编码的。索赔人和开处方者的人口统计学数据可用。2007 年对处方索赔应用了 30 项 STOPP 指标。多水平逻辑回归检查了 PIP 在开处方者之间以及个体患者和开处方者水平变量之间的变化。
开处方者之间未经调整的 PIP 差异相当大（中位数为 35%，IQR 为 30-40%）。STOPP 标准是 PIP 的可靠衡量标准（平均>0.8 可靠性）。多水平回归模型发现，只有患者水平变量，即不同重复药物类别的数量与 PIP 密切相关（>2 种药物与无药物；调整后的 OR，4.0；95%CI 3.7，4.3）。在调整了患者水平变量后，开处方者之间的 PIP 比例差异四倍（0.5 到 2 倍于预期比例），但大多数差异并不显著。
所有开处方者都应关注 PIP。旨在提高处方适当性的干预措施应针对服用多种药物的患者。
