Atramont Alice, Bonnet-Zamponi Dominique, Bourdel-Marchasson Isabelle, Tangre Isabelle, Fagot-Campagna Anne, Tuppin Philippe
Caisse Nationale d'Assurance Maladie (CNAMTS), Paris, France.
Centre de pharmaco-épidémiologie de l'APHP, OMEDIT Observatoire des MEdicaments Dispositifs médicaux et Innovations Thérapeutiques d'Ile de France, Paris, France.
Eur J Clin Pharmacol. 2018 Jan;74(1):109-118. doi: 10.1007/s00228-017-2343-y. Epub 2017 Oct 3.
Changes in prescribing practices following skilled nursing home (SNH) admission have not been clearly described in France. The study aimed to evaluate health status and drug use 1 year before and 1 year after admission to SNH.
People ≥ 65 years old admitted to SNH in the first quarter of 2013, covered by the national health insurance general scheme (69% of the population of this age) and still alive 1 year after admission were identified in a specific database (Resid-ehpad). Linking with the National Health Insurance Information System (SNIIRAM) allowed analysis of their health status, identified by algorithms, and changes in their use of reimbursed drugs.
In a population of 11,687 residents (mean age: 86 years, women: 76%), the most prevalent diseases were cardiovascular/neurovascular diseases (45%) and dementias (35%). The use of certain chronic treatments (≥ 3 reimbursements/year) increased significantly (p < 0.001) after nursing home admission: antidepressants: 34 to 46%, anxiolytics: 32 to 42%, hypnotics/sedatives: 18 to 24%, antipsychotics: 10 to 21% (14 to 30% in patients with dementia). The use of lipid-modifying agents and agents acting on the renin-angiotensin system decreased significantly (33 to 24% and 44 to 37%, respectively, p < 0.001). The use of antibacterials (≥ 1 reimbursement/year) increased also significantly (p < 0.001): 45 to 61%, including quinolones (13 to 20%) and third-generation cephalosporins (10 to 18%).
These results reveal increased prescribing of psychotropic drugs and antibacterials in SNH, requiring the development or sustainability of actions designed to improve prescribing practices in older people targeted by these treatments.
在法国，关于入住专业护理院（SNH）后处方行为的变化尚未得到清晰描述。本研究旨在评估入住SNH前1年和入住后1年的健康状况及药物使用情况。
在一个特定数据库（Resid-ehpad）中识别出2013年第一季度入住SNH、纳入国家健康保险一般计划（该年龄段人口的69%）且入住后1年仍存活的65岁及以上人群。与国家健康保险信息系统（SNIIRAM）相链接，得以分析通过算法确定的他们的健康状况以及报销药物使用情况的变化。
在11687名居民（平均年龄：86岁，女性：76%）中，最常见的疾病是心血管/神经血管疾病（45%）和痴呆症（35%）。入住护理院后，某些慢性治疗药物（每年≥3次报销）的使用显著增加（p<0.001）：抗抑郁药：从34%增至46%，抗焦虑药：从32%增至42%，催眠药/镇静剂：从18%增至24%，抗精神病药：从10%增至21%（痴呆症患者中从14%增至30%）。调脂药和作用于肾素 - 血管紧张素系统的药物使用显著减少（分别从33%降至24%和从44%降至37%，p<0.001）。抗菌药物（每年≥1次报销）的使用也显著增加（p<0.001）：从45%增至61%，包括喹诺酮类（从13%增至20%）和第三代头孢菌素（从10%增至18%）。
这些结果显示SNH中精神药物和抗菌药物的处方量增加，需要开展或持续采取行动以改善针对接受这些治疗的老年人的处方行为。
