Grina D, Briedis V
Department of Clinical Pharmacy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
J Clin Pharm Ther. 2017 Apr;42(2):195-200. doi: 10.1111/jcpt.12494. Epub 2017 Feb 2.
The prevalence and risk factors for prescribing and using potentially inappropriate medications (PIMs) has been extensively researched in Western Europe and the United States of America; however, research in Central and Eastern Europe remains highly limited. According to a recent systematic review, the overall estimated weighted prevalence of PIM prescribing in community-dwelling elderly in Europe (expressed as a percentage of patients or prescriptions with ≥1 PIM) was 22·6% (95% CI: 19·5%-26·7%). The main objective of this study was to investigate the prevalence of use of PIMs among the elderly in Lithuania according to different sets of published explicit criteria and compare the results with similar research carried out in other European countries.
This was a retrospective, observational cross-sectional population-based (n = 431 625) study using the medicines reimbursement claims data covering a 1-year period. The use of PIMs was measured based on 2003 Beers criteria, 2015 AGS Beers criteria and the EU(7)-PIM list. The prevalence was measured as the percentage of patients with at least 1 PIM during 1-year period. Multivariate logistic regression was used to identify risk factors for PIM prescription.
The prevalence of PIM use varied from 24·1% according to 2003 Beers criteria and 25·9% according to 2015 AGS Beers criteria, to 57·2% according to the EU(7)-PIM list. Polypharmacy and increasing age had increased the risk of PIM use. Women had an increased risk for prescription of the EU(7)-PIM listed medications compared with men, whereas for Beers drugs the risk in women was lower. Benzodiazepines were the most commonly prescribed PIMs according to all criteria.
The use of PIMs is highly prevalent among the Lithuanian elderly and there is a great need of interventions to improve the pharmacotherapy in this age group.
在西欧和美国，开具和使用潜在不适当药物（PIMs）的患病率及风险因素已得到广泛研究；然而，中东欧地区的研究仍然极为有限。根据最近的一项系统评价，欧洲社区居住老年人中PIMs处方的总体加权患病率估计值（以至少有一种PIMs的患者或处方的百分比表示）为22.6%（95%置信区间：19.5%-26.7%）。本研究的主要目的是根据不同组已发表的明确标准，调查立陶宛老年人中PIMs的使用患病率，并将结果与其他欧洲国家开展的类似研究进行比较。
这是一项回顾性、基于人群的横断面观察研究（n = 431625），使用了涵盖1年时间的药品报销申请数据。基于2003年《Beers标准》、2015年美国老年医学会（AGS）《Beers标准》和欧盟（7）-PIM清单来衡量PIMs的使用情况。患病率以1年期间至少有一种PIMs的患者百分比来衡量。采用多变量逻辑回归来确定PIMs处方的风险因素。
根据2003年《Beers标准》，PIMs的使用患病率为24.1%，根据2015年AGS《Beers标准》为25.9%，而根据欧盟（7）-PIM清单则为57.2%。多重用药和年龄增长增加了PIMs使用的风险。与男性相比，女性开具欧盟（7）-PIM清单所列药物的风险增加，而对于《Beers标准》中的药物，女性的风险较低。根据所有标准，苯二氮䓬类药物是最常开具的PIMs。
PIMs在立陶宛老年人中使用极为普遍，非常需要采取干预措施来改善该年龄组的药物治疗。
