检测非常高龄老年人潜在不适当处方：来自 BELFRAIL 观察性队列研究数据的横断面分析。
Detection of potentially inappropriate prescribing in the very old: cross-sectional analysis of the data from the BELFRAIL observational cohort study.
机构信息
Pharmacy department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium.
出版信息
BMC Geriatr. 2015 Dec 2;15:156. doi: 10.1186/s12877-015-0149-2.
BACKGROUND
Little is known about the prevalence and clinical importance of potentially inappropriate prescribing instances (PIPs) in the very old (>80 years). The main objective was to describe the prevalence of PIPs according to START (Screening Tool to Alert doctors to Right Treatment; omissions) and,STOPP (Screening Tool of Older Person's Prescriptions; over/misuse) and the Beers list (over/misuse). Secondary objectives were to identify determinants if PIPs and to assess the clinical importance to modify the treatment in case of PIPs.
METHODS
Cross-sectional analysis of baseline data of the BELFRAIL cohort, which included 567 Belgian patients aged 80 and older in primary care. Two independent researchers applied the screening tools to the study population to detect PIPs. Next, a multidisciplinary panel of experts rated the clinical importance of the PIPs on a subsample of 50 patients.
RESULTS
In this very old population (median age 84 years, 63 % female), the screening detected START-PIPs in 59 % of patients, STOPP-PIPs in 41 % and Beers-PIPs in 32 %. Assessment of the clinical importance revealed that the most frequent PIPs were of moderate or major importance. In 28 % of the subsample, the relevance of the PIP was challenged by the global medical, functional and social background of the patient hence the validity of some criteria was questioned.
CONCLUSION
Potentially inappropriate prescribing is highly prevalent in the very old. A good understanding of the patients' medical, functional and social context is crucial to assess the actual appropriateness of drug treatment.
背景
对于非常高龄（>80 岁）人群中潜在不适当处方（PIP）的流行程度和临床重要性知之甚少。主要目的是根据 START（识别医生正确治疗的筛选工具；遗漏）和 STOPP（老年人处方筛选工具；过度/误用）以及 Beers 清单（过度/误用）来描述 PIP 的流行程度。次要目标是确定 PIP 的决定因素，并评估修改治疗方案的临床重要性。
方法
对 BELFRAIL 队列的基线数据进行横断面分析，该队列包括 567 名在初级保健中年龄在 80 岁及以上的比利时患者。两名独立研究人员将筛选工具应用于研究人群，以检测 PIP。然后，一个多学科专家小组对 50 名患者的亚样本进行 PIP 临床重要性评估。
结果
在这个非常高龄的人群中（中位数年龄 84 岁，63%为女性），59%的患者存在 START-PIP，41%的患者存在 STOPP-PIP，32%的患者存在 Beers-PIP。对临床重要性的评估表明，最常见的 PIP 具有中度或高度重要性。在亚样本的 28%中，患者的整体医疗、功能和社会背景对 PIP 的相关性提出了挑战，因此一些标准的有效性受到了质疑。
结论
非常高龄人群中潜在不适当的处方非常普遍。充分了解患者的医疗、功能和社会背景对于评估药物治疗的实际适当性至关重要。
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