养老院中潜在不适当用药情况：一项采用挪威养老院用药标准（NORGEP-NH）的观察性研究
Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria.
作者信息
Nyborg Gunhild, Brekke Mette, Straand Jørund, Gjelstad Svein, Romøren Maria
机构信息
Department of General Practice/Family Medicine, HELSAM, Institute of Health and Society, University of Oslo, P.o. Box 1130 Blindern, 0318, Oslo, Norway.
出版信息
BMC Geriatr. 2017 Sep 19;17(1):220. doi: 10.1186/s12877-017-0608-z.
BACKGROUND
Frail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors.
METHODS
Cross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway. Data collected 2009-11 included residents' demographic and clinical status and all medications, regular and on demand.
RESULTS
881 patients from 30 institutions (mean 85.9 years, 68.6% female), were included. According to NORGEP-NH, 43.8% were prescribed at least one potentially inappropriate regular medication, and 9.9% regularly received three or more potentially inappropriate medications. When also including a) the NORGEP-NH Deprescribing Criteria and b) including drugs prescribed for use as needed, 92.7% of all residents received medication that needs particular surveillance according to the NORGEP-NH. 69.7% of the nursing home residents used at least one psychotropic drug regularly. Female residents received more often than males at least one potentially inappropriate regular medication (OR 1.60, p=0.007). Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1.79 (p=0.03) compared to males. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs. Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration (odds ratio 1.70, p=0.009).
CONCLUSIONS
Prevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially the use of multiple psychotropic drugs. The high prevalence found in this study shows that there is a need for higher awareness of medication use and side effects in the elderly population.
TRIAL REGISTRATION
Retrospectively registered. Data obtained from clinical trial NCT01023763 registered with ClinicalTrials.gov 12/01/2009.
背景
疗养院中的体弱居民在用药方面需要格外关注。挪威全科医疗疗养院（NORGEP-NH）制定了一份包含34条明确标准的清单，用于判定疗养院中潜在不适当用药情况，该清单就是专门针对这一人群制定的。本研究旨在运用NORGEP-NH标准来研究疗养院居民中潜在不适当用药的程度，并探究可能的相关因素。
方法
对挪威韦斯特福尔郡疗养院的居民进行横断面观察性药物流行病学研究。2009年至2011年收集的数据包括居民的人口统计学和临床状况以及所有常规和按需服用的药物。
结果
纳入了来自30家机构的881名患者（平均年龄85.9岁，女性占68.6%）。根据NORGEP-NH标准，43.8%的患者至少开具了一种潜在不适当的常规药物，9.9%的患者定期服用三种或更多潜在不适当的药物。若同时纳入a）NORGEP-NH减药标准以及b）按需开具的药物，根据NORGEP-NH标准，92.7%的居民所服用的药物需要特别监测。69.7%的疗养院居民经常使用至少一种精神药物。女性居民比男性居民更常至少开具一种潜在不适当的常规药物（比值比1.60，p = 0.007）。关于三种或更多种精神药物联合使用的处方情况，女性与男性相比，比值比为1.79（p = 0.03）。日常生活活动能力表现最佳的居民以及长期病房的居民使用三种或更多种精神药物的风险更高。在感染或脱水急性发作期间，使用多种精神活性药物会增加跌倒风险（比值比1.70，p = 0.0
Zotero 插件