McCracken Rita, McCormack James, McGregor Margaret J, Wong Sabrina T, Garrison Scott
Department of Family Medicine, Providence Health Care, Vancouver, Canada.
Department of Family Practice, University of British Columbia, Vancouver, Canada.
BMJ Open. 2017 Aug 11;7(8):e017430. doi: 10.1136/bmjopen-2017-017430.
Describe nursing home polypharmacy prevalence in the context of prescribing for diabetes and hypertension and determine possible associations between lower surrogate markers for treated hypertension and diabetes (overtreatment) and polypharmacy.
Cross-sectional study.
6 nursing homes in British Columbia, Canada.
214 patients residing in one of the selected facilities during data collection period.
Polypharmacy was defined as ≥9 regular medications. Overtreatment of diabetes was defined as being prescribed at least one hypoglycaemic medication and a glycosylated haemoglobin (HbA1c) ≤7.5%. Overtreatment of hypertension required being prescribed at least one hypertension medication and having a systolic blood pressure ≤128 mm Hg. Polypharmacy prescribing, independent of overtreatment, was calculated by subtracting condition-specific medications from total medications prescribed.
Data gathering was completed for 214 patients, 104 (48%) of whom were prescribed ≥9 medications. All patients were very frail. Patients with polypharmacy were more likely to have a diagnosis of hypertension (p=0.04) or congestive heart failure (p=0.003) and less likely to have a diagnosis of dementia (p=0.03). Patients with overtreated hypertension were more likely to also experience polypharmacy (Relative Risk (RR))1.77 (1.07 to 2.96), p=0.027). Patients with overtreated diabetes were prescribed more non-diabetic medications than those with a higher HbA1c (11.0±3.7vs 7.2±3.1, p=0.01).
Overtreated diabetes and hypertension appear to be prevalent in nursing home patients, and the presence of polypharmacy is associated with more aggressive treatment of these risk factors. The present study was limited by its small sample size and cross-sectional design. Further study of interventions designed to reduce overtreatment of hypertension and diabetes is needed to fully understand the potential links between polypharmacy and potential of harms of condition-specific overtreatment.
描述在糖尿病和高血压处方背景下疗养院多重用药的患病率，并确定治疗高血压和糖尿病的较低替代指标（过度治疗）与多重用药之间可能存在的关联。
横断面研究。
加拿大不列颠哥伦比亚省的6家疗养院。
在数据收集期间居住在所选设施之一的214名患者。
多重用药定义为≥9种常规药物。糖尿病过度治疗定义为开具至少一种降糖药物且糖化血红蛋白（HbA1c）≤7.5%。高血压过度治疗要求开具至少一种高血压药物且收缩压≤128mmHg。独立于过度治疗的多重用药处方通过从总处方药物中减去特定疾病药物来计算。
完成了对214名患者的数据收集，其中104名（48%）患者开具了≥9种药物。所有患者都非常虚弱。多重用药患者更有可能被诊断为高血压（p = 0.04）或充血性心力衰竭（p = 0.003），而被诊断为痴呆的可能性较小（p = 0.03）。高血压过度治疗的患者也更有可能经历多重用药（相对风险（RR））1.77（1.07至2.96），p = 0.027）。糖尿病过度治疗的患者比HbA1c较高的患者开具了更多的非糖尿病药物（1
