Arnoldo Luca, Cattani Giovanni, Cojutti Piergiorgio, Pea Federico, Brusaferro Silvio
Department of Medical and Biological Sciences, University of Udine.
Institute of Clinical Pharmacology , Complex Local Health Unit, Udine, Italy.
J Public Health Res. 2016 Dec 9;5(3):745. doi: 10.4081/jphr.2016.745.
Polypharmacy is a main issue of patient safety in all healthcare settings (i.e. increase adverse drug reactions and incidence of drug-drug interactions, etc.). The main object of the study was to evaluate the prevalence of polypharmacy and the appropriateness of drugs prescriptions in the regional health system (RHS) of Friuli Venezia-Giulia Region, Italy.
We carried out a point prevalence study in May 2014; 1582 patients ≥65 years were included from: 14 acute hospitals, 46 Long Term Care Facilities (LTCFs) and 42 general practitioners' (GPs) clinics. Data analysis included the evaluation of (PIPs) taking Beers criteria as a reference.
Patients in therapy with 10 drugs or more were 13.5%: 15.2% in hospitals, 9.7% in GPs' clinics and 15.6% in LTCFs. According to Beers criteria we identified 1152 PIPs that involved globally almost half of patients (46.0%): 41.9% in hospitals, 59.6% in LTCFs and 37.0% in GP's clinics. The 53.9% of patients received at least one mainly kidney excreted drug; for these patients the evaluation of serum creatinine was overall present in the 87.7% (747/852): 96.4% in hospital ones, 87.5% in GPs' clinics and 77.8% in LTCFs. LTCFs residents were significantly (P<0.05) more exposed to PIPs and less monitored for the renal function.
A reliable estimation of the phenomenon in all the main healthcare settings is a necessary prerequisite to set tailored policies for facing polypharmacy within a RHS; the results showed the necessity to put a special attention on LTCFs.
在所有医疗环境中，多重用药都是患者安全的一个主要问题（即增加药物不良反应和药物相互作用的发生率等）。本研究的主要目的是评估意大利弗留利-威尼斯朱利亚地区区域卫生系统（RHS）中多重用药的患病率以及药物处方的合理性。
我们于2014年5月开展了一项现况研究；纳入了来自14家急症医院、46家长期护理机构（LTCF）和42家全科医生（GP）诊所的1582名年龄≥65岁的患者。数据分析包括以Beers标准为参考对潜在不适当处方（PIP）进行评估。
接受10种或更多药物治疗的患者占13.5%：医院中为15.2%，全科医生诊所中为9.7%，长期护理机构中为15.6%。根据Beers标准，我们识别出1152例PIP，这些PIP总共涉及近一半的患者（46.0%）：医院中为41.9%，长期护理机构中为59.6%，全科医生诊所中为37.0%。53.9%的患者接受了至少一种主要经肾脏排泄的药物；对于这些患者，血清肌酐评估总体上在87.7%（747/852）的患者中进行：医院患者中为96.4%，全科医生诊所患者中为87.5%，长期护理机构患者中为77.8%。长期护理机构的居民明显（P<0.05）更容易出现PIP，且肾功能监测较少。
在所有主要医疗环境中对该现象进行可靠评估是在区域卫生系统内制定应对多重用药的针对性政策的必要前提；结果表明有必要特别关注长期护理机构。
