一项调查预测因素在医疗保险护理院居民中启动的膀胱抗毒蕈碱药物的类型。
An investigation of factors predicting the type of bladder antimuscarinics initiated in Medicare nursing homes residents.
机构信息
Department of Pharmacy Practice and Science, College of Pharmacy; Department of Epidemiology, College of Public Health; Sanders-Brown Center on Aging; Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, 789 S Limestone Street, Room 241, Lexington, KY, 40536, USA.
Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA.
出版信息
BMC Geriatr. 2017 Dec 28;17(1):295. doi: 10.1186/s12877-017-0690-2.
BACKGROUND
To examine factors predicting type of bladder antimuscarinics (BAM) initiated in nursing home (NH) residents.
METHODS
Incident BAM initiators following NH admission were identified by constructing a retrospective cohort from Medicare files and Minimum Data Set (MDS). Participants included all residents 65 years and older admitted in Medicare-certified NH between January 1, 2007 and December 31, 2008 who were prescribed BAM and had continuous Medicare (Part A, B, and D) enrollment. Patient characteristics, medications, and comorbidities were derived from Medicare enrollment and claims. NH characteristics and health status were derived from MDS assessments. The outcome was defined as type of BAM initiated after admission (selective, non-selective extended release, non-selective immediate release). Multinomial logistic regression using generalized estimating equation methodology determined which factors predicted the type of BAM initiated.
RESULTS
Twelve thousand eight hundred ninety-nine NH residents initiating BAM therapy were identified; 13.38% of new users were prescribed selective BAM, 45.56% non-selective extended release, and 41.07% non-selective immediate release medications. In both sexes, significant predictors of BAM included region of nursing home, body mass index, cognitive performance score, frailty measures, activities of daily living, and measures of bladder continence. In women, history of fracture and fall-related injuries were significant predictors of type of BAM use, while race and indicators of balance were significant predictors of type of BAM use in men. Non-pharmacological continence management strategies were not predictive of type of BAM initiation.
CONCLUSIONS
Several factors are important in predicting type of BAM initiation in both women and men, but other factors are sex-specific. Some observed factors predicting the type of BAM initiated, such as other medications use, body mass index, or provider-related factors are potentially modifiable and could be used in targeted interventions to help optimize BAM use in this population.
TRIAL REGISTRATION
Not applicable.
背景
研究预测养老院（NH）居民开始使用膀胱抗毒蕈碱药物（BAM）类型的因素。
方法
通过从医疗保险文件和最低数据集中构建回顾性队列，确定 NH 入院后开始使用 BAM 的事件。参与者包括所有在 2007 年 1 月 1 日至 2008 年 12 月 31 日期间在医疗保险认证 NH 入院的 65 岁及以上的居民，他们被处方 BAM 并持续参加医疗保险（A 部分、B 部分和 D 部分）。患者特征、药物和合并症均来自医疗保险登记和索赔。NH 特征和健康状况来自 MDS 评估。结果定义为入院后开始使用的 BAM 类型（选择性、非选择性延长释放、非选择性即时释放）。使用广义估计方程方法的多变量逻辑回归确定了预测 BAM 类型的因素。
结果
确定了 2899 名开始使用 BAM 治疗的 NH 居民；新使用者中 13.38%被处方选择性 BAM，45.56%非选择性延长释放，41.07%非选择性即时释放药物。在男女两性中，BAM 的显著预测因素包括 NH 区域、体重指数、认知表现评分、虚弱程度、日常生活活动和膀胱控测措施。在女性中，骨折和与跌倒相关的损伤史是 BAM 使用类型的重要预测因素，而种族和平衡指标是男性 BAM 使用类型的重要预测因素。非药物性控测管理策略不能预测 BAM 起始类型。
结论
在女性和男性中，有几个因素对预测 BAM 起始类型很重要，但其他因素是性别特异性的。一些观察到的预测 BAM 起始类型的因素，如其他药物的使用、体重指数或提供者相关因素，是潜在可改变的，可用于有针对性的干预，以帮助优化该人群中 BAM 的使用。
试验注册
不适用。
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