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Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study.联合用药、潜在不适当用药及抗胆碱能负担对临床结局的影响:一项回顾性队列研究
CMAJ. 2015 Mar 3;187(4):E130-E137. doi: 10.1503/cmaj.141219. Epub 2015 Feb 2.
2
Multimorbidity of chronic diseases and health care utilization in general practice.基层医疗中慢性病的多重疾病状态与医疗保健利用情况
BMC Fam Pract. 2014 Apr 7;15:61. doi: 10.1186/1471-2296-15-61.
3
Polypharmacy and health outcomes among older adults discharged from hospital: results from the CRIME study.老年患者出院后的多重用药与健康结局:CRIME研究结果
Geriatr Gerontol Int. 2015 Feb;15(2):141-6. doi: 10.1111/ggi.12241. Epub 2014 Jan 28.
4
Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs.合并症、多种并存疾病、并发症的概念及其临床流行病学类似物。
Clin Epidemiol. 2013 Jul 1;5:199-203. doi: 10.2147/CLEP.S45305. Print 2013.
5
The IMPACT clinic: innovative model of interprofessional primary care for elderly patients with complex health care needs.IMPACT 诊所:为有复杂医疗需求的老年患者提供的多专业初级保健创新模式。
Can Fam Physician. 2013 Mar;59(3):e148-55.
6
Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: a randomised controlled study.通过药物审查改善老年初级保健患者的药物治疗质量:一项随机对照研究。
Drugs Aging. 2013 Apr;30(4):235-46. doi: 10.1007/s40266-013-0057-0.
7
American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults.美国老年医学学会更新了老年人潜在不适当药物使用的 Beers 标准。
J Am Geriatr Soc. 2012 Apr;60(4):616-31. doi: 10.1111/j.1532-5415.2012.03923.x. Epub 2012 Feb 29.
8
The impact of polypharmacy on the health of Canadian seniors.多药治疗对加拿大老年人健康的影响。
Fam Pract. 2012 Aug;29(4):427-32. doi: 10.1093/fampra/cmr124. Epub 2012 Jan 5.
9
Inappropriate medication use among the elderly: a systematic review of administrative databases.老年人用药不当:行政数据库的系统评价。
BMC Geriatr. 2011 Nov 30;11:79. doi: 10.1186/1471-2318-11-79.
10
Patterns of ambulatory medical care utilization in elderly patients with special reference to chronic diseases and multimorbidity--results from a claims data based observational study in Germany.老年慢性病和多病种患者门诊医疗利用模式——基于德国理赔数据的观察性研究结果。
BMC Geriatr. 2011 Sep 13;11:54. doi: 10.1186/1471-2318-11-54.

合并症和药物治疗对老年患者初级保健就诊频率的影响。

Effect of comorbidities and medications on frequency of primary care visits among older patients.

作者信息

Hu Tina, Dattani Neil D, Cox Kelly Anne, Au Bonnie, Xu Leo, Melady Don, Jaakkimainen Liisa, Jain Rahul, Charles Jocelyn

机构信息

Medical student, at the University of Toronto in Ontario.

Second-year family medicine resident, at the University of Toronto in Ontario.

出版信息

Can Fam Physician. 2017 Jan;63(1):45-50.

PMID:28115442
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5257221/
Abstract

OBJECTIVE

To determine if comorbidities and high-risk medications affect the frequency of family physician visits among older patients.

DESIGN

Retrospective chart review.

SETTING

Academic family health team at Sunnybrook Health Sciences Centre in Toronto, Ont.

PARTICIPANTS

Among patients aged 65 years and older who were registered patients of the family health team between July 1, 2013, and June 30, 2014, the 5% who visited their family physicians most frequently and the 5% who visited their family physicians least frequently were selected for the study (N = 265).

MAIN OUTCOME MEASURES

Predictors of frequent visits to family physicians.

RESULTS

The significant predictors of being a high-frequency user were female sex (odds ratio [OR] = 2.20, P = .03), age older than 85 years (OR = 5.35, P = .001), and higher total number of medications (OR = 1.49, P < .001). Age-adjusted Charlson comorbidity index score, number of Beers criteria medications, and Anticholinergic Risk Scale score were not significant predictors (P > .05).

CONCLUSION

Female sex, age older than 85, and higher total number of medications were independent significant predictors of higher frequency of family physician visits among older patients. Validated tools, such as the Charlson comorbidity index, Beers criteria, and Anticholinergic Risk Scale, did not independently predict the frequency of visits, indicating that predicting frequency of visits is likely complex.

摘要

目的

确定合并症和高风险药物是否会影响老年患者看家庭医生的频率。

设计

回顾性病历审查。

地点

安大略省多伦多市桑尼布鲁克健康科学中心的学术家庭健康团队。

参与者

在2013年7月1日至2014年6月30日期间作为家庭健康团队注册患者的65岁及以上患者中,选择看家庭医生最频繁的5%和最不频繁的5%进行研究(N = 265)。

主要观察指标

看家庭医生频繁的预测因素。

结果

高频率就诊者的显著预测因素为女性(比值比[OR]=2.20,P = .03)、年龄大于85岁(OR = 5.35,P = .001)以及药物总数较多(OR = 1.49,P < .001)。年龄调整后的查尔森合并症指数评分、符合Beers标准的药物数量以及抗胆碱能风险量表评分不是显著预测因素(P > .05)。

结论

女性、年龄大于85岁以及药物总数较多是老年患者看家庭医生频率较高的独立显著预测因素。经过验证的工具,如查尔森合并症指数、Beers标准和抗胆碱能风险量表,并不能独立预测就诊频率,这表明预测就诊频率可能很复杂。