Herr Marie, Grondin Helene, Sanchez Stéphane, Armaingaud Didier, Blochet Caroline, Vial Antoine, Denormandie Philippe, Ankri Joël
INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France.
Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, 2, avenue de la source de la Bièvre, F-78180, Montigny le Bretonneux, France.
Eur J Clin Pharmacol. 2017 May;73(5):601-608. doi: 10.1007/s00228-016-2193-z. Epub 2017 Jan 16.
The quality of drug therapy is an important issue for nursing homes. This study aimed to assess the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a large sample of nursing home residents by using the data recorded during the preparation of pill dispensers.
This is a cross-sectional study that included 451 nursing homes across France. Information about the medications received by the 30,702 residents (73.8% women) living in these nursing homes was extracted from the system that assists in the preparation of pill dispensers in pharmacies. The anonymized database included age, sex, and medications prescribed to residents, as well as nursing home characteristics (capacity, legal status). Factors associated with excessive polypharmacy (≥10 different drugs) and PIMs according to the Laroche list were studied using multilevel regression models.
The average number of drugs prescribed was 6.9 ± 3.3, and excessive polypharmacy concerned 21.1% of the residents (n = 6468). According to the Laroche list, 47.4% of residents (n = 14,547) received at least one PIM. Benzodiazepines (excessive doses, long-acting benzodiazepines, and combination of benzodiazepines) and anticholinergic medications (hydroxyzine, cyamemazine, alimemazine) accounted for a large part of PIMs. Individual characteristics (age, gender) influenced the risk of receiving PIMs whereas nursing home characteristics (capacity, legal status) influenced the risk of excessive polypharmacy.
This study shows that polypharmacy and PIMs remain highly prevalent among nursing home residents. Main PIMs concerned psychotropic and anticholinergic medications.
药物治疗质量是养老院的一个重要问题。本研究旨在通过使用配药准备过程中记录的数据，评估大量养老院居民中多重用药和潜在不适当用药（PIMs）的流行情况。
这是一项横断面研究，纳入了法国各地的451家养老院。从协助药房配药的系统中提取了居住在这些养老院的30702名居民（73.8%为女性）所接受药物的信息。匿名数据库包括年龄、性别、居民所开药物以及养老院特征（容量、法律地位）。使用多水平回归模型研究与过度多重用药（≥10种不同药物）和根据拉罗什清单确定的PIMs相关的因素。
所开药物的平均数量为6.9±3.3种，21.1%的居民（n = 6468）存在过度多重用药情况。根据拉罗什清单，47.4%的居民（n = 14547）接受了至少一种PIM。苯二氮䓬类药物（过量剂量、长效苯二氮䓬类药物以及苯二氮䓬类药物组合）和抗胆碱能药物（羟嗪、氰美马嗪、异丁嗪）占PIMs的很大一部分。个体特征（年龄、性别）影响接受PIMs的风险，而养老院特征（容量、法律地位）影响过度多重用药的风险。
本研究表明，多重用药和PIMs在养老院居民中仍然非常普遍。主要的PIMs涉及精神药物和抗胆碱能药物。
