Jokanovic Natali, Tan Edwin C K, Dooley Michael J, Kirkpatrick Carl M, Bell J Simon
Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia; Pharmacy Department, Alfred Hospital, Melbourne, Australia.
Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia.
J Am Med Dir Assoc. 2015 Jun 1;16(6):535.e1-12. doi: 10.1016/j.jamda.2015.03.003. Epub 2015 Apr 11.
The objective of the study was to investigate the prevalence of, and factors associated with, polypharmacy in long-term care facilities (LTCFs).
MEDLINE, EMBASE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library were searched from January 2000 to September 2014. Primary research studies in English were eligible for inclusion if they fulfilled the following criteria: (1) polypharmacy was quantitatively defined, (2) the prevalence of polypharmacy was reported or could be extracted from tables or figures, and (3) the study was conducted in a LTCF. Methodological quality was assessed using an adapted version of the Joanna Briggs Institute Critical Appraisal Checklist.
Forty-four studies met the inclusion criteria and were included. Polypharmacy was most often defined as 5 or more (n = 11 studies), 9 (n = 13), or 10 (n = 11) medications. Prevalence varied widely between studies, with up to 91%, 74%, and 65% of residents taking more than 5, 9, and 10 medications, respectively. Seven studies performed multivariate analyses for factors associated with polypharmacy. Positive associations were found for recent hospital discharge (n = 2 studies), number of prescribers (n = 2), and comorbidity including circulatory diseases (n = 3), endocrine and metabolic disorders (n = 3), and neurological motor dysfunctioning (n = 3). Older age (n = 5), cognitive impairment (n = 3), disability in activities of daily living (n = 3), and length of stay in the LTCF (n = 3) were inversely associated with polypharmacy.
The prevalence of polypharmacy in LTCFs is high, varying widely between facilities, geographical locations and the definitions used. Greater use of multivariate analysis to investigate factors associated with polypharmacy across a range of settings is required. Longitudinal research is needed to explore how polypharmacy has evolved over time.
本研究旨在调查长期护理机构（LTCFs）中多重用药的患病率及其相关因素。
检索了2000年1月至2014年9月期间的MEDLINE、EMBASE、国际药学文摘、护理学与健康相关文献累积索引以及Cochrane图书馆。纳入的英文原发性研究需符合以下标准：（1）对多重用药进行了定量定义；（2）报告了多重用药的患病率，或可从表格或图表中提取该患病率；（3）研究在长期护理机构中进行。使用乔安娜·布里格斯研究所批判性评价清单的改编版评估方法学质量。
44项研究符合纳入标准并被纳入。多重用药最常被定义为服用5种或更多（n = 11项研究）、9种（n = 13项）或10种（n = 11项）药物。不同研究之间患病率差异很大，分别有高达91%、74%和65%的居民服用超过5种、9种和10种药物。7项研究对与多重用药相关的因素进行了多变量分析。发现近期出院（n = 2项研究）、开处方者数量（n = 2项）以及包括循环系统疾病（n = 3项）、内分泌和代谢紊乱（n = 3项）和神经运动功能障碍（n = 3项）在内的合并症呈正相关。年龄较大（n = 5项）、认知障碍（n = 3项）、日常生活活动能力残疾（n = 3项）以及在长期护理机构的住院时间（n = 3项）与多重用药呈负相关。
长期护理机构中多重用药的患病率很高，在不同机构、地理位置和所使用的定义之间差异很大。需要更多地使用多变量分析来研究一系列环境中与多重用药相关的因素。需要进行纵向研究以探索多重用药随时间的演变情况。
