与老年人在初级卫生保健中使用潜在不适当药物相关的因素：比较 AGS Beers、EU(7)-PIM List 和巴西共识 PIM 标准的分析。
Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria.
机构信息
Faculdade de Farmácia da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
Instituto de Ciências Exatas da Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
出版信息
Res Social Adm Pharm. 2019 Apr;15(4):370-377. doi: 10.1016/j.sapharm.2018.06.002. Epub 2018 Jun 15.
BACKGROUND
Potentially inappropriate medications (PIM) for the older adults are those with an unfavorable risk-benefit ratio when more effective and safe therapeutic alternatives are available and is an important public health problem.
PURPOSE
To analyze the factors associated with the use of PIM by the older adults and to investigate the agreement of PIM use frequency using the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015 AGS Beers Criteria, the Brazilian consensus on potentially inappropriate medication for older adults (BCPIM) and the European union list of potentially inappropriate medications - EU (7)-PIM List.
METHODS
This is a cross-sectional study conducted in two primary health care centers in southeastern Brazil. The 2015 AGS Beers Criteria, BCPIM, and EU (7)-PIM List were used for the classification of PIM. The association between PIM use and independent variables was assessed by multiple logistic regression. The level of agreement of PIM use among the three criteria was measured with the Cohen's kappa coefficient.
RESULTS
A total of 227 patients ≥60 years of age were included in the study. The frequency of PIM use was 53.7% for 2015 AGS Beers, 55.9% for BCPIM and 63.4% for the EU (7)-PIM List. The agreement between 2015 AGS Beers and BCPIM and between this and the EU (7)-PIM List was high, and moderate between the 2015 AGS Beers and the EU (7)-PIM List. Logistic regression showed association of PIM use with polypharmacy, self-reported neuropsychiatric and musculoskeletal diseases, age ≤70 years, preserved cognition and positive self-perception of health.
CONCLUSION
The frequency of PIM use by the older adults of health centers investigated is high. Strategies for improving the pharmacotherapy of the older adults in primary health care should be implemented.
背景
老年人潜在不适当药物（PIM）是指在有更有效和安全的治疗替代方案时，风险效益比不利的药物，这是一个重要的公共卫生问题。
目的
分析与老年人使用 PIM 相关的因素，并调查使用 2015 年美国老年医学会不适当药物使用标准-2015 年美国老年医学会不适当药物使用标准（2015 AGS Beers Criteria）、巴西老年人潜在不适当药物共识（BCPIM）和欧盟潜在不适当药物清单-欧盟 7 号 PIM 清单（EU （7）-PIM List）评估 PIM 使用频率的一致性。
方法
这是一项在巴西东南部的两个初级保健中心进行的横断面研究。使用 2015 年美国老年医学会不适当药物使用标准、BCPIM 和欧盟 7 号 PIM 清单对 PIM 进行分类。使用多因素逻辑回归评估 PIM 使用与独立变量之间的相关性。使用 Cohen's kappa 系数测量三个标准之间 PIM 使用的一致性。
结果
共纳入 227 名≥60 岁的患者。2015 年美国老年医学会不适当药物使用标准、BCPIM 和欧盟 7 号 PIM 清单的 PIM 使用频率分别为 53.7%、55.9%和 63.4%。2015 年美国老年医学会不适当药物使用标准与 BCPIM 之间以及与欧盟 7 号 PIM 清单之间的一致性较高，与欧盟 7 号 PIM 清单之间的一致性为中等。逻辑回归显示，PIM 使用与多种药物治疗、自我报告的神经精神和肌肉骨骼疾病、年龄≤70 岁、认知保留和健康自我感知呈正相关。
结论
研究中心老年人使用 PIM 的频率较高。应在初级保健中实施改善老年人药物治疗的策略。
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