School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
BMJ Open. 2018 Jun 27;8(6):e021727. doi: 10.1136/bmjopen-2018-021727.
Adverse drug events (ADEs) are common in older persons and contribute significantly to emergency department visits, hospitalisations and mortality. ADEs are often due to potentially inappropriate prescriptions (PIP) or potentially inappropriate omissions (PIO), and are avoidable if inappropriate prescriptions or omissions are identified and prevented. Identifying PIP/PIO at the population level through the application of PIP/PIO assessment tools to health administrative data can provide a unique opportunity to assess the economic burden of PIP/PIO on the healthcare system beyond medication costs which is yet to be done. The objective of this study is to assess the economic burden associated with PIP/PIO and to estimate the incremental costs associated with distinct PIP/PIO in the province of Ontario.
We will conduct a retrospective cohort study using Ontario's health administrative databases. Eligible patients aged 66 years and older who were prescribed at least one medication between 1 April 2003 and 31 March 2014 (approximately 2.4 million patients) will be included. Population attributable fraction methodology will be used to assess the overall burden of PIP in Ontario, while regression analyses will be used to estimate the incremental costs of having specific PIP criteria and aid in prioritising targets for intervention.
This study was approved by the Institutional Review Board at Sunnybrook Health Sciences Centre, Toronto, Canada. Dissemination will occur via publication, presentation at national and international conferences, and knowledge exchange with various stakeholders.
药物不良事件（ADE）在老年人中很常见，并且是导致急诊科就诊、住院和死亡的主要原因。ADE 通常是由于潜在不合理处方（PIP）或潜在不合理遗漏（PIO）引起的，如果能够识别和预防不合理的处方或遗漏，则可以避免。通过将 PIP/PIO 评估工具应用于健康管理数据，可以在人群层面上识别 PIP/PIO，从而为评估 PIP/PIO 对医疗保健系统的经济负担提供独特的机会，而不仅仅是药物成本，这一点尚未得到充分评估。本研究的目的是评估与 PIP/PIO 相关的经济负担，并估计安大略省特定 PIP/PIO 相关的增量成本。
我们将使用安大略省的健康管理数据库进行回顾性队列研究。符合条件的患者为年龄在 66 岁及以上，在 2003 年 4 月 1 日至 2014 年 3 月 31 日期间至少开具了一种药物（约 240 万患者）。将使用人群归因分数方法评估安大略省 PIP 的总体负担，同时回归分析将用于估计具有特定 PIP 标准的增量成本，并有助于确定干预目标的优先级。
本研究已获得加拿大多伦多桑尼布鲁克健康科学中心机构审查委员会的批准。传播将通过发表文章、在国内外会议上发表演讲以及与各种利益相关者进行知识交流来实现。
