Université Sorbonne, Université Pierre et Marie Curie-Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, UMR 1136, Paris, France; Université Sorbonne, Université Pierre et Marie Curie-Paris 06, Biological adaptation and Aging, INSERM, UMR 8256, Paris, France; Assistance Publique Hopitaux de Paris, Pitié-Salpêtrière Hospital, Geriatric Department, Paris, France.
Université Sorbonne, Université Pierre et Marie Curie-Paris 06, Biological adaptation and Aging, INSERM, UMR 8256, Paris, France; Assistance Publique Hopitaux de Paris, Pitié-Salpêtrière Hospital, Geriatric Department, Paris, France; University Hospital Department Fight Aging and Stress (DHU FAST), APHP, Paris, France.
J Am Med Dir Assoc. 2017 Jun 1;18(6):549.e1-549.e13. doi: 10.1016/j.jamda.2017.02.001. Epub 2017 Mar 18.
Elderly people are at risk of repeated hospitalizations, some of which may be drug related and preventable. In 2011, a group of French healthcare experts selected 5 iatrogenic alerts (IAs), based on criteria identified in a literature search and from their professional experience, to assess the appropriateness of medication in elderly patients.
Our objective was to examine the association between hospitalizations and IAs in elderly patients treated for Alzheimer disease who are particularly sensitive to adverse drug events.
A 2-year (January 1, 2011, to December 31, 2012) longitudinal national database study, with a study design similar to self-controlled case series, was performed to analyze data on drug prescriptions and hospitalization. IAs were defined as (1) long half-life benzodiazepine; (2) antipsychotic drugs in patients with Alzheimer disease; (3) co-prescription of 3 or more psychotropic drugs; (4) co-prescription of 2 or more diuretics; and (5) co-prescription of 4 or more antihypertensive drugs. Data were obtained by matching of 2 French National Health Insurance Databases.
France.
All affiliates, aged ≥75 years, receiving treatment for Alzheimer disease, alive on January 1, 2011 were included.
We calculated the relative increase in the number of hospitalizations in patients with IAs. The analysis was performed over four 6-month periods.
A total of 10,754 patients were included. During the periods with IAs, hospitalization rates increased by 0.36/year compared with 0.23/year in the periods without for the same patient, and the number of hospitalizations doubled [proportional fold change = 1.9, 95% confidence interval (1.8, 2.1)]. We estimated that 22% [95% confidence interval (20%, 23%)] of all hospitalizations were associated with IAs, 80% of which were due to psychotropic IAs.
The IAs could be used as a simple and clinically relevant tool by prescribing physicians to assess the appropriateness of the prescription in elderly patients treated for Alzheimer disease.
老年人存在反复住院的风险，其中一些可能与药物有关且可以预防。2011 年，一组法国医疗保健专家根据文献检索和专业经验确定的标准，选择了 5 种医源性警示（IAs），以评估老年患者用药的适宜性。
我们的目的是研究在易发生药物不良反应的阿尔茨海默病老年患者中，住院与 IAs 之间的关系。
一项为期 2 年（2011 年 1 月 1 日至 2012 年 12 月 31 日）的纵向全国数据库研究，采用类似于自身对照病例系列的研究设计，分析药物处方和住院数据。IAs 定义为：（1）长半衰期苯二氮䓬类药物；（2）阿尔茨海默病患者使用的抗精神病药物；（3）同时开具 3 种或以上精神药物；（4）同时开具 2 种或以上利尿剂；（5）同时开具 4 种或以上降压药。数据通过匹配法国 2 个国家健康保险数据库获得。
法国。
所有年龄≥75 岁、正在接受阿尔茨海默病治疗且于 2011 年 1 月 1 日存活的参保者。
我们计算了 IAs 患者住院人数的相对增加。分析在四个 6 个月期间进行。
共纳入 10754 例患者。在有 IAs 的期间，与同一患者无 IAs 的同期相比，住院率每年增加 0.36/年，住院人数增加一倍[比例变化倍数=1.9，95%置信区间（1.8，2.1）]。我们估计，所有住院的 22%[95%置信区间（20%，23%）]与 IAs 有关，其中 80%是由于精神类 IAs。
IAs 可以作为一种简单且具有临床相关性的工具，供处方医生使用，以评估治疗阿尔茨海默病的老年患者处方的适宜性。
