Schulze J, Freitag M H, Glaeske G, Schmiemann G, Hoffmann F
Abteilung Gesundheitsökonomie, Gesundheitspolitik und Versorgungsforschung, Zentrum für Sozialpolitik, Universität Bremen, Mary-Somerville-Straße 3, 28359, Bremen, Deutschland,
Schmerz. 2015 Jul;29(3):276-84. doi: 10.1007/s00482-015-0003-7.
Pain is a highly prevalent symptom in nursing home residents. The analgesic pharmacotherapy of older adults is associated with challenges; however, studies from Germany examining the prescription pattern of analgesics in nursing home residents are rare.
This study was carried out to examine the prescription of analgesics in nursing home residents with and without the diagnosis of cancer.
Using health insurance claims data persons aged ≥ 65 years who were newly admitted to a nursing home between 2004 and 2009 and who survived at least the first 90 days after admission were included in the study. Cancer was identified by outpatient diagnoses of malignant neoplasms (ICD-10: C00-C97). Prescription drugs within the first 90 days after admission to a nursing home were analyzed which means that aspirin and acetaminophen were not taken into account.
A total of 5549 nursing home residents were included, who were on average 81.5 years old (56.8 % females). More than half (53.5 %) were assigned to care level I and 781 (14.1 %) were diagnosed with cancer. The study cohort received on average 7.8 different medications (with vs. without cancer: 8.6 vs. 7.6, respectively) and 43.8 % had prescriptions for analgesics (with vs. without cancer: 52.5 vs. 42.3 %, respectively). A total of 37.1 % were taking WHO step 1 analgesics (step 2: 11.4 % and step 3: 9.2 %). The proportion of persons receiving metamizole (dipyrone) was 28.3 % (with vs. without cancer: 35.6 vs. 27.1 %, respectively). Regarding all prescriptions, metamizole was by far the most frequently prescribed medication in nursing homes followed by melperone and omeprazole.
Approximately one third of nursing home residents received metamizole and most were long-term prescriptions. Considering that metamizole is associated with potentially life-threatening adverse effects, caution is indicated particularly when prescribed over long periods.
疼痛是疗养院居民中极为常见的症状。老年人的镇痛药物治疗存在诸多挑战；然而，德国针对疗养院居民镇痛药处方模式的研究却很少见。
本研究旨在调查有无癌症诊断的疗养院居民的镇痛药处方情况。
利用医疗保险理赔数据，纳入2004年至2009年间新入住疗养院且入院后至少存活90天的65岁及以上人群。通过门诊恶性肿瘤诊断（国际疾病分类第十版：C00-C97）来确定癌症。分析入住疗养院后前90天内的处方药，这意味着未将阿司匹林和对乙酰氨基酚纳入考虑范围。
共纳入5549名疗养院居民，平均年龄81.5岁（女性占56.8%）。超过一半（53.5%）被分配到一级护理水平，781人（14.1%）被诊断患有癌症。研究队列平均接受7.8种不同药物治疗（有癌症与无癌症者分别为8.6种和7.6种），43.8%的人有镇痛药处方（有癌症与无癌症者分别为52.5%和42.3%）。共有37.1%的人服用世界卫生组织第一阶梯镇痛药（第二阶梯：11.4%，第三阶梯：9.2%）。接受安乃近（双氯芬酸钠）治疗的比例为28.3%（有癌症与无癌症者分别为35.6%和27.1%）。在所有处方中，安乃近是疗养院中迄今为止最常开具的药物，其次是美哌隆和奥美拉唑。
约三分之一的疗养院居民接受了安乃近治疗，且大多数为长期处方。鉴于安乃近可能会带来危及生命的不良反应，尤其是长期开具处方时需谨慎。
