Guthrie Bruce, Makubate Boikanyo, Hernandez-Santiago Virginia, Dreischulte Tobias
Population Health Sciences Division, Medical Research Institute, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK.
Department of Public Health, Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana.
BMC Med. 2015 Apr 7;13:74. doi: 10.1186/s12916-015-0322-7.
The escalating use of prescribed drugs has increasingly raised concerns about polypharmacy. This study aims to examine changes in rates of polypharmacy and potentially serious drug-drug interactions in a stable geographical population between 1995 and 2010.
This is a repeated cross-sectional analysis of community-dispensed prescribing data for all 310,000 adults resident in the Tayside region of Scotland in 1995 and 2010. The number of drug classes dispensed and the number of potentially serious drug-drug interactions (DDIs) in the previous 84 days were calculated, and age-sex standardised rates in 1995 and 2010 compared. Patient characteristics associated with receipt of ≥ 10 drugs and with the presence of one or more DDIs were examined using multilevel logistic regression to account for clustering of patients within primary care practices.
Between 1995 and 2010, the proportion of adults dispensed ≥ 5 drugs doubled to 20.8%, and the proportion dispensed ≥ 10 tripled to 5.8%. Receipt of ≥ 10 drugs was strongly associated with increasing age (20-29 years, 0.3%; ≥ 80 years, 24.0%; adjusted OR, 118.3; 95% CI, 99.5-140.7) but was also independently more common in people living in more deprived areas (adjusted OR most vs. least deprived quintile, 2.36; 95% CI, 2.22-2.51), and in people resident in a care home (adjusted OR, 2.88; 95% CI, 2.65-3.13). The proportion with potentially serious drug-drug interactions more than doubled to 13% of adults in 2010, and the number of drugs dispensed was the characteristic most strongly associated with this (10.9% if dispensed 2-4 drugs vs. 80.8% if dispensed ≥ 15 drugs; adjusted OR, 26.8; 95% CI 24.5-29.3).
Drug regimens are increasingly complex and potentially harmful, and people with polypharmacy need regular review and prescribing optimisation. Research is needed to better understand the impact of multiple interacting drugs as used in real-world practice and to evaluate the effect of medicine optimisation interventions on quality of life and mortality.
处方药使用的不断增加日益引发了对多重用药的担忧。本研究旨在调查1995年至2010年间一个稳定地理区域人群中多重用药率及潜在严重药物相互作用的变化情况。
这是一项对1995年和2010年居住在苏格兰泰赛德地区的所有310,000名成年人社区配药处方数据的重复横断面分析。计算了所配药类数量以及前84天内潜在严重药物相互作用（DDIs）的数量，并比较了1995年和2010年的年龄-性别标准化率。使用多水平逻辑回归分析来考虑初级医疗服务机构内患者的聚集情况，研究与接受≥10种药物以及存在一种或多种DDIs相关的患者特征。
1995年至2010年间，配药≥5种药物的成年人比例翻倍至20.8%，配药≥10种药物的比例增至三倍，达5.8%。接受≥10种药物与年龄增长密切相关（20 - 29岁，0.3%；≥80岁，24.0%；调整后的比值比，118.3；95%置信区间，99.5 - 140.7），但在生活在更贫困地区的人群中也更常见（调整后的比值比，最贫困五分位数与最不贫困五分位数相比，2.36；95%置信区间，2.22 - 2.51），且在养老院居住的人群中也更常见（调整后的比值比，2.88；95%置信区间，2.65 - 3.13）。2010年，有潜在严重药物相互作用的成年人比例增加了一倍多，达到13%，所配药物数量是与此最密切相关的特征（配药2 - 4种时为10.9%，配药≥15种时为80.8%；调整后的比值比，26.8；95%置信区间，24.5 - 29.3）。
药物治疗方案日益复杂且可能有害，多重用药患者需要定期复查和优化处方。需要开展研究以更好地了解现实世界中多种相互作用药物的影响，并评估药物优化干预对生活质量和死亡率的效果。
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