Van Heerden J A, Burger J R, Gerber J J
Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University (Potchefstroom campus), South Africa.
S Afr Med J. 2016 Sep 9;106(10):1010-1016. doi: 10.7196/SAMJ.2016.v106i10.10627.
Prescribing for older patients is a well-recognised problem, and inappropriate items are prescribed frequently. Several tools and criteria are available to promote rational prescribing in older patients.
To determine the prevalence of potentially inappropriate prescriptions (PIPs) in older South African patients.
A retrospective drug utilisation review was conducted using medicine claims data over a 1-year period. Patients aged ≥65 years with at least one paid claim for any medicine item during this period were included. The prevalence of PIPs was identified by applying the 2012-Beers criteria list.
A total of 103 420 patients, mean age 74.0 years (standard deviation 6.7), 57.1% female, were included in the analysis. The number of PIPs identified was 562 852 in 71 206 patients (68.9%). The most common medicines inappropriately prescribed were oestrogen (oral and patch formulations only) (12.4%), meloxicam (7.3%), amitriptyline and combinations thereof (6.5%), diclofenac (6.4%), ibuprofen (6.1%), alprazolam (5.3%), meprobamate and combinations thereof (5.0%), sliding-scale insulin (3.3%), amiodarone (3.1%) and doxazosin (2.6%). Medicines were inappropriately prescribed to women statistically significantly more often than to men (1.9:1; p<0.001), although this difference was not of practical significance (Cramér's V=0.06).
Medicine use in older patients must be appropriate and evaluated regularly. According to explicit criteria, PIPs were found to be common in older patients registered on the database. Monitoring of PIPs may increase the quality of prescribing, but explicit criteria cannot substitute for clinical judgement based on the individual patient.
为老年患者开药是一个公认的问题，不适当的药物经常被开出。有几种工具和标准可用于促进老年患者的合理用药。
确定南非老年患者中潜在不适当处方（PIP）的患病率。
使用1年期间的药品报销数据进行回顾性药物利用审查。纳入在此期间年龄≥65岁且至少有一项任何药品付费报销的患者。通过应用2012年版《美国老年医学会黑名单》标准清单确定PIP的患病率。
共有103420名患者纳入分析，平均年龄74.0岁（标准差6.7），女性占57.1%。在71206名患者（68.9%）中确定的PIP数量为562852条。最常被不适当开出的药物是雌激素（仅口服和贴片剂型）（12.4%）、美洛昔康（7.3%）、阿米替林及其组合（6.5%）、双氯芬酸（6.4%）、布洛芬（6.1%）、阿普唑仑（5.3%）、眠尔通及其组合（5.0%）、滑动比例胰岛素（3.3%）、胺碘酮（3.1%）和多沙唑嗪（2.6%）。从统计学上看，女性被不适当开药的频率明显高于男性（1.9:1；p<0.001），尽管这种差异不具有实际意义（克莱姆V系数=0.06）。
老年患者的用药必须恰当并定期评估。根据明确标准，在数据库登记患者中发现PIP很常见。监测PIP可能会提高处方质量，但明确标准不能替代基于个体患者的临床判断。
