Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.
NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.
BMC Geriatr. 2018 Jan 11;18(1):9. doi: 10.1186/s12877-018-0704-8.
The potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care.
Participants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults.
Of all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted β = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care.
The use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs.
某些药物的潜在危害可能超过其潜在益处（用药不当）。尽管有建议避免在老年人中使用潜在不适当的药物（PIM），但在不同环境中包括养老院中，PIM 的使用仍然很普遍。然而，目前尚不清楚在这种环境下这些药物的成本是多少。本研究的主要目的是确定居住在养老院的老年人中 PIM 的成本。次要目的是检查在类似于家庭的养老院模式与澳大利亚标准护理模式下，PIM 的成本是否存在差异。
参与者包括来自调查在住宅环境中提供的服务以治疗痴呆症（INSPIRED）研究的 541 名参与者。INSPIRED 研究是一项在澳大利亚 17 个养老院进行的横断面研究。确定了参与者在 12 个月内的药物费用，并使用 2015 年更新的老年人 Beers 标准来确定 PIM。
在 1 年内开出的所有药物中，15.9%是 PIM，81.4%的参与者接触过 PIM。对数线性模型显示，接触 PIM 与更高的总药物费用相关（调整后的β=0.307，95%CI 0.235 至 0.379，p<0.001）。在 1 年内，用于 PIM 的药物费用的平均比例（±SD）为 17.5%（±17.8）（暴露于 PIM 的每位参与者花费 410.89 澳元±479.45 澳元）。最大的 PIM 费用来自质子泵抑制剂（34.4%）、抗精神病药（21.0%）和苯二氮䓬类（18.7%）。与标准护理模式相比，居住在类似家庭的护理模式中的患者发生 PIM 费用的可能性降低了 52%。
养老院中老年人使用 PIM 的情况很高，这些药物的成本很高，有可能降低。进一步的研究应调查在这一人群中进行药物审查是否会导致潜在的成本节约和临床结果的改善。采用类似家庭的养老院模式可能与降低 PIM 的流行率和成本有关。
