Projovic Ivana, Vukadinovic Dubravka, Milovanovic Olivera, Jurisevic Milena, Pavlovic Radisa, Jacovic Sasa, Jankovic Slobodan, Stefanovic Srdjan
Department for Clinical Pharmacy, University of Kragujevac, Faculty of Medical Sciences, Svetozara Markovica 69, 34000, Kragujevac, Serbia.
Department of Clinical Pharmacology, Clinical Center of Kragujevac, Kragujevac, Serbia.
Eur J Clin Pharmacol. 2016 Jan;72(1):93-107. doi: 10.1007/s00228-015-1957-1. Epub 2015 Sep 29.
The aim of this study is to determine modifiable risk factors contributing to potentially inappropriate prescribing in older primary care outpatients (≥65 years).
Two separate, age- and sex-matched case-control studies were carried out simultaneously at the Primary Health Care Center Kragujevac, Serbia, during the period September 2013-September 2014. The cases were defined as patients with at least one prescription for potentially inappropriate medication (PIM) according to Screening Tool of Older Persons potentially inappropriate Prescriptions (STOPP) criteria (n = 122), and patients who had at least one potential prescribing omission (PPO) listed in Screening Tool to Alert doctors to the Right Treatment (START) criteria (n = 108), while the control groups consisted of patients without such outcomes (n = 244 and n = 216, respectively).
A total of 138 PIM and 161 PPO events were identified using 26 (41.3 %) of STOPP criteria and 17 (77.3 %) of START indicators, respectively. The unhealthy behaviors including at least two of the following: sedentary lifestyle, improper nutrition, active smoking or heavy alcohol consumption (adjusted OR 2.57, 95 % CI 1.28-5.20), use of multiple drugs (five to eight drugs, adjusted OR 3.05, 95 % CI 1.59-5.85; ≥9 of drugs adjusted OR 7.17, 95 % CI 3.07-16.74) and frequent contacts between patients chosen general practitioners (GPs) and pharmaceutical sales representatives (adjusted OR 2.28, 95 % CI 1.10-4.75), were identified as major risk factors for PIM use. Patients who were handled by GPs from smaller practices (adjusted OR 0.51, 95 % CI 0.29-0.93), those with more organ systems affected by the extremely severe disorders and those who often visited the outpatient specialist services (adjusted OR 0.88, 95 % CI 0.81-0.95), had a significantly reduced risk of PPO.
This study suggests that avoidance of major polypharmacy, use of nonpharmacological measures to improve lifestyle habits and decreasing the exposure of physicians to drug promotional material may reduce the risk of PIM use in older primary care outpatients. The only modifiable protective factors for PPOs were working environment of the patients chosen GPs and more frequent ambulatory visits to specialists.
本研究旨在确定导致老年初级保健门诊患者（≥65岁）潜在不适当处方的可改变风险因素。
2013年9月至2014年9月期间，在塞尔维亚克拉古耶瓦茨初级卫生保健中心同时进行了两项独立的、年龄和性别匹配的病例对照研究。病例定义为根据老年人潜在不适当处方筛查工具（STOPP）标准至少有一张潜在不适当药物（PIM）处方的患者（n = 122），以及根据提醒医生正确治疗筛查工具（START）标准至少有一项潜在处方遗漏（PPO）的患者（n = 108），而对照组由没有此类结果的患者组成（分别为n = 244和n = 216）。
分别使用26项（41.3%）STOPP标准和17项（77.3%）START指标确定了总共138例PIM事件和161例PPO事件。不健康行为包括以下至少两项：久坐不动的生活方式、营养不当、主动吸烟或大量饮酒（调整后的OR为2.57，95%CI为1.28 - 5.20）、使用多种药物（五至八种药物，调整后的OR为3.05，95%CI为1.59 - 5.85；≥9种药物调整后的OR为7.17，95%CI为3.07 - 16.74）以及患者所选全科医生（GP）与药品销售代表之间频繁接触（调整后的OR为2.28，95%CI为1.10 - 4.75），被确定为使用PIM的主要风险因素。由规模较小诊所的全科医生诊治的患者（调整后的OR为0.51，95%CI为0.29 - 0.93）、受极其严重疾病影响的器官系统较多的患者以及经常就诊门诊专科服务的患者（调整后的OR为0.88，95%CI为0.81 - 0.95），发生PPO的风险显著降低。
本研究表明，避免大量用药、采用非药物措施改善生活习惯以及减少医生接触药品促销材料可能会降低老年初级保健门诊患者使用PIM的风险。PPO唯一可改变的保护因素是患者所选全科医生的工作环境以及更频繁地门诊就诊于专科医生。
