[根据“STOPP”标准,多重用药的老年患者中潜在不适当处方情况]

[Potentially inappropriate prescription according to the "STOPP" Criteria in heavily polymedicated elderly patients].

作者信息

Terán-Álvarez L, González-García M J, Rivero-Pérez A L, Alonso-Lorenzo J C, Tarrazo-Suárez J A

机构信息

Centro de Salud de Siero-Sariego, Asturias, España.

Centro de Salud de Siero-Sariego, Asturias, España.

出版信息

Semergen. 2016 Jan-Feb;42(1):2-10. doi: 10.1016/j.semerg.2014.10.018. Epub 2014 Dec 29.

Abstract

INTRODUCTION

Appropriate prescribing is especially relevant in elderly people. The objective of this study is to analyse the potentially inappropriate prescription (PIP) in heavily polymedicated elderly patients according to the criteria Screening Tool of Older Person's Prescriptions.

PATIENTS AND METHODS

A descriptive cross-sectional study was conducted in Primary Care on patients assigned to the Siero-Sariego (Asturias) Health Centre, who were over 64 years old and heavily polymedicated (consumption >10 drugs for six months). The 65 Screening Tool of Older Person's Prescriptions criteria were reviewed in the electronic Primary Care patient records, collecting sociodemographic variables, prescribed medications, and chronic diseases. Frequency distributions were made for each criterion, and causes related to PIP were explored using contingency tables, the Spearman correlation coefficient, and logistic regression.

RESULTS

A total of 349 polymedicated elderly patients were analysed with a prevalence of 6.4 (95% CI:5.76-7.08), a mean age of 79.2 years (SD:3.7), 62.2% were female, 14% institutionalised, a Charlson index of 2.9. The mean of number of drugs was 11.5 (SD:1.7), and the most frequent pathologies were high blood pressure (64%), diabetes (46%), and osteoarticular diseases (41%). There was at least one PIP in 72.9% of heavily polymedicated elderly patients [(Mean: 1.32 (SD:1.2)]. The Screening Tool of Older Person's Prescriptions criteria least complied with were: therapeutic duplication (25.2%), use of long-acting benzodiazepines (15.8%), and inappropriate use of aspirin (10.9%). An association was found between having any inappropriate prescription and the number of medications prescribed (OR=1.22 [95% CI:1.04-1.43]) and inversely to the Charlson index (OR=0.76 [95% CI:0.65-0.89]).

CONCLUSIONS

PIP is common in heavily polymedicated elderly patients. Special attention must be paid to the use of psychotropic drugs, which are implicated in a high volume of PIP.

摘要

引言

合理用药在老年人中尤为重要。本研究的目的是根据老年人处方筛查工具标准,分析多重用药的老年患者中潜在不适当处方(PIP)情况。

患者与方法

在西埃罗-萨列戈(阿斯图里亚斯)健康中心的基层医疗中,对64岁以上且多重用药(连续6个月服用超过10种药物)的患者进行了描述性横断面研究。在基层医疗电子病历中审查了65项老年人处方筛查工具标准,收集社会人口统计学变量、所开药物和慢性病信息。对每个标准进行频率分布分析,并使用列联表、Spearman相关系数和逻辑回归探讨与PIP相关的原因。

结果

共分析了349例多重用药的老年患者,患病率为6.4(95%可信区间:5.76 - 7.08),平均年龄79.2岁(标准差:3.7),女性占62.2%,14%为机构养老,Charlson指数为2.9。平均用药数量为11.5(标准差:1.7),最常见的疾病是高血压(64%)、糖尿病(46%)和骨关节疾病(41%)。72.9%的多重用药老年患者至少有一项PIP [均值:1.32(标准差:1.2)]。老年人处方筛查工具标准最不符合的是:治疗重复(25.2%)、长效苯二氮䓬类药物的使用(15.8%)和阿司匹林的不当使用(10.9%)。发现有任何不适当处方与所开药物数量之间存在关联(比值比=\(1.22\) [95%可信区间:1.04 - 1.43]),与Charlson指数呈负相关(比值比=\(0.76\) [95%可信区间:0.65 - 0.89])。

结论

PIP在多重用药的老年患者中很常见。必须特别关注精神药物的使用,其与大量PIP有关。

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