Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Geriatric Center Kayseri Education and Research Hospital, Kayseri, Turkey.
Clin Interv Aging. 2018 Apr 9;13:607-613. doi: 10.2147/CIA.S159966. eCollection 2018.
Polypharmacy and inappropriate drug use cause numerous complications, such as cognitive impairment, frailty, falls, and functional dependence. The present study aimed to determine the effect of the comprehensive geriatric assessment (CGA) on polypharmacy, potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), and to evaluate the economic reflections of medication changes.
One thousand five hundred and seventy-nine older patients, who had undergone CGA, were retrospectively evaluated. The drugs, drug groups, and number of drugs that the patients used were recorded. Appropriate drug therapy was identified by both CGA and STOPP/START criteria. Based on these criteria, PIMs were discontinued and PPOs were started. The monthly cost of these drugs was calculated separately for PIMs and PPOs by using the drugstore records.
After CGA, while the prevalence of non-polypharmacy was increased from 43.3% to 65.6%, the prevalence of polypharmacy and hyperpolypharmacy was decreased from 56.7% to 34.4% and 12.0% to 3.6%, respectively. The three most common PIMs discontinued were proton pump inhibitors, anti-dementia drugs, and antipsychotics, respectively. However, the most common PPOs started were vitamin D and B12 supplements, and anti-depressants. After CGA, monthly saved total per capita cost of PIMs was US$12.8 and monthly increased total per capita cost of PPOs was $5.6.
It was demonstrated that prevalence of polypharmacy, PIM, and PPO could be decreased by CGA including START/STOPP criteria in older adults. Furthermore, this will have beneficial effects on economical parameters due to decreasing drug-related health care costs.
多种药物治疗和不适当的药物使用会导致许多并发症，如认知障碍、虚弱、跌倒和功能依赖。本研究旨在确定综合老年评估（CGA）对多种药物治疗、潜在不适当药物（PIMs）和潜在药物遗漏（PPOs）的影响，并评估药物治疗改变的经济影响。
回顾性评估了 1579 名接受 CGA 的老年患者。记录患者使用的药物、药物组和药物数量。通过 CGA 和 STOPP/START 标准确定适当的药物治疗。根据这些标准，停用了 PIMs 并开始使用 PPOs。通过使用药店记录，分别计算这些药物的 PIMs 和 PPOs 的每月费用。
CGA 后，非多种药物治疗的患病率从 43.3%增加到 65.6%，而多种药物治疗和超多种药物治疗的患病率从 56.7%降至 34.4%和 12.0%。停用的三种最常见的 PIMs 分别是质子泵抑制剂、抗痴呆药物和抗精神病药物。然而，开始使用的最常见的 PPOs 是维生素 D 和 B12 补充剂以及抗抑郁药。CGA 后，PIMs 的人均每月节省总成本为 12.8 美元，PPOs 的人均每月增加总成本为 5.6 美元。
研究表明，通过包括 START/STOPP 标准的 CGA，可以降低老年人的多种药物治疗、PIM 和 PPO 的患病率。此外，由于降低了与药物相关的医疗保健费用，这将对经济参数产生有益的影响。
