Service de Pharmacie, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France.
Observatoire du Médicament des Dispositifs Médicaux et de l'Innovation Thérapeutique Ile de France, Paris, France.
J Am Geriatr Soc. 2017 Dec;65(12):2713-2719. doi: 10.1111/jgs.15081. Epub 2017 Oct 9.
To determine whether potentially inappropriate medications (PIMs) or potentially inappropriate associations (PIAs) prescribed knowingly are associated with patient monitoring.
Prospective observational study.
Geriatric units (n = 56) in 28 hospitals.
Inpatients aged 75 and older (N = 1,327).
Potentially inappropriate prescriptions (PIP) were defined as a PIM or a PIA selected by an expert board from lists of explicit criteria (Beers, Priscus, Laroche, French Health Agency) using a Delphi process. They were considered to be prescribed knowingly if they were maintained after reassessment by the geriatrician and the clinical pharmacist. Primary outcome was the rate of PIPs maintained (prescribed knowingly) and for which a geriatrician declared that specific monitoring was performed. Secondary outcomes were the parameters monitored and the rate of participants receiving knowingly a PIP.
One thousand sixty-three PIPs were detected in 607 participants (46%). After reassessment, 826 (78%) PIPs were maintained in 490 participants (37%), the main reasons being participant's regular treatment and lack of alternative. Psychotropic (36%), cardiovascular (including antithrombotics) (29%), and laxative or antiemetic drugs (16%) were the most-frequent classes prescribed knowingly. The geriatricians declared to perform clinical or biological monitoring for 69% (n = 570) of PIMs or PIAs prescribed knowingly. Three types of specific monitoring were identified: clinical, biological, and follow-up with a specialist.
Approximately three-quarters of PIMs or PIAs were prescribed knowingly, of which 69% were monitored, with wide variations in occurrence and in quality according to drug classes. This underlines the need for accurate guidelines on PIP monitoring.
确定明知故犯开具的潜在不适当药物（PIM）或潜在不适当联合用药（PIA）是否与患者监测相关。
前瞻性观察性研究。
28 家医院的老年病房（n=56）。
75 岁及以上的住院患者（N=1327）。
潜在不适当处方（PIP）定义为专家委员会根据明确标准（Beers、Priscus、Laroche、法国卫生署）从清单中选择的 PIM 或 PIA，采用德尔菲法。如果在老年病医生和临床药师重新评估后仍保留处方，则认为是明知故犯。主要结局是保留（明知故犯）的 PIP 率，以及老年病医生宣布对特定患者进行特定监测的 PIP 率。次要结局是监测的参数和明知故犯接受 PIP 的患者比例。
在 607 名参与者中发现了 1063 种 PIP，其中 46%的参与者存在。经过重新评估，490 名参与者中有 826 种（78%）PIP 保留，主要原因是患者的常规治疗和缺乏替代治疗。明知故犯开具的最常见药物类别为精神类药物（36%）、心血管类（包括抗血栓药物）（29%）和轻泻药或止吐药（16%）。老年病医生宣布对 69%（n=570）明知故犯开具的 PIM 或 PIA 进行临床或生物学监测。确定了三种类型的特定监测：临床、生物学和专科随访。
大约四分之三的 PIM 或 PIA 是明知故犯开具的，其中 69%的药物进行了监测，不同药物类别之间的发生和质量存在很大差异。这突显了准确的 PIP 监测指南的必要性。
