Clinical Pharmacology Research Unit, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
Centre For Research and Innovation in Care (CRIC), University of Antwerp, Wilrijk, Belgium.
Basic Clin Pharmacol Toxicol. 2019 Jan;124(1):62-73. doi: 10.1111/bcpt.13095. Epub 2018 Aug 16.
To explore the feasibility of the electronic assessment of potentially inappropriate medication (PIM) criteria in a large administrative database and to explore the validity of the cardiovascular subset of PIM criteria, by studying the association with relevant outcome.
A cohort study using administrative data from Stockholm County, Sweden (VAL database). Eligible for inclusion were community-dwelling older people (≥65 years), alive in Stockholm County on 31 December 2015. We applied PIM criteria pertaining to the cardiovascular medication group (first-level ATC C group), and we assessed the association between PIM use and mortality and hospitalisation.
Patients' (n = 315 120) mean age was 74.0 years (range 65-114), and 54.7% were women. There were 111 cardiovascular PIM criteria in the repository, from which 44 were not registered or prescribed in our population. We excluded another 43 requiring information not available in the database, or duplicates, resulting in 24 applicable criteria. The prevalence of polypharmacy (≥ five medications) was 25.5% and the prevalence of at least one PIM use was 8.3%, including 2.8% underuse and 5.3% misuse. Patients with intake of ≥10 medications had 38% increased mortality risk compared to those with 0-4 medications. Unplanned hospitalisation and emergency department visits were positively associated with underuse (12% and 25%, respectively) and misuse (13% and 12%, respectively).
It was feasible to select a subset of cardiovascular PIM criteria originating from different PIM lists and to apply this subset in an administrative database. Additionally, by applying this subset, we showed significant associations with clinical outcome.
探索在大型行政数据库中对潜在不适当药物（PIM）标准进行电子评估的可行性，并通过研究与相关结果的关联来探索 PIM 标准心血管亚组的有效性。
这是一项使用瑞典斯德哥尔摩县行政数据（VAL 数据库）的队列研究。符合纳入标准的是居住在斯德哥尔摩县的社区老年人（≥65 岁），截至 2015 年 12 月 31 日在斯德哥尔摩县仍然存活。我们应用了心血管药物组（第一级 ATC C 组）的 PIM 标准，并评估了 PIM 使用与死亡率和住院之间的关联。
患者（n=315120）的平均年龄为 74.0 岁（范围 65-114），54.7%为女性。存储库中有 111 个心血管 PIM 标准，其中 44 个在我们的人群中未被登记或开具。我们排除了另外 43 个需要数据库中不可用的信息或重复的标准，结果有 24 个适用的标准。多药治疗（≥5 种药物）的患病率为 25.5%，至少使用一种 PIM 的患病率为 8.3%，包括 2.8%的用药不足和 5.3%的用药不当。与使用 0-4 种药物的患者相比，使用≥10 种药物的患者死亡率风险增加 38%。非计划住院和急诊就诊与用药不足（分别为 12%和 25%）和用药不当（分别为 13%和 12%）呈正相关。
从不同的 PIM 清单中选择心血管 PIM 标准的子集并将其应用于行政数据库是可行的。此外，通过应用这个子集，我们显示了与临床结果的显著关联。
