Nagoya University Graduate School of Medicine, Department of Community Healthcare & Geriatrics, Showa-ku, Nagoya, Aichi, Japan.
E-Da Hospital, Department of Family Medicine, Jiaosu Village, Yanchao District, Kaohsiung City, Taiwan, R.O.C.
PLoS One. 2019 Feb 8;14(2):e0211947. doi: 10.1371/journal.pone.0211947. eCollection 2019.
Although potentially inappropriate medications (PIMs) have been linked to poor health outcomes, country-specific PIM criteria have not been compared. Thus, we compared the identification of PIMs between the Screening Tool for Older Person's Appropriate Prescriptions for Japanese (STOPP-J) and the 2015 American Geriatrics Society Beers Criteria in elderly patients receiving home-based medical services.
A 5-year prospective cohort study was conducted with 196 patients receiving home-based medical services. Data were collected using questionnaires and chart reviews and included detailed information on prescription medication. STOPP-J and the Beers Criteria were used to categorize PIM and non-PIM recipients. All-cause mortality and first hospitalization were compared using a multivariate Cox regression model.
PIMs were detected in 132 patients (67.3%) by STOPP-J and in 141 patients (71.9%) by the Beers Criteria, and the mean numbers of PIMs were 1.3 ± 1.3 and 1.2 ± 1.1, respectively. The three most frequently prescribed STOPP-J PIMs were hypnotics (26.8%), diuretics (25.6%), and NSAIDs (12.6%), compared with proton pump inhibitors (PPIs) (29.8%), hypnotics (26%), and NSAIDs (8.1%) according to the Beers Criteria. STOPP-J PIMs were associated with all-cause mortality (HR 3.01, 95% CI 1.37-6.64) and hospitalization (HR 1.91, 95% CI 1.17-3.09); neither was associated with Beers Criteria PIMs. Using a modified Beers Criteria (excluding PPIs), PIMs were correlated with first hospitalization (HR 1.91, 95% CI 1.17-3.09).
PIMs categorized by STOPP-J are associated with hospitalization and mortality in Japanese patients receiving home-based medical services. PPIs, commonly used for acid-related diseases, do not seem to have deleterious effects on health outcomes. Country-oriented, medication-specific criteria would be of considerable clinical utility.
尽管潜在不适当药物（PIMs）与不良健康结果有关，但尚未比较特定于国家的 PIM 标准。因此，我们比较了接受家庭医疗服务的老年患者中用于识别 PIM 的 Screening Tool for Older Person's Appropriate Prescriptions for Japanese（STOPP-J）和 2015 年美国老年医学会 Beers 标准。
进行了一项为期 5 年的前瞻性队列研究，共纳入 196 名接受家庭医疗服务的患者。使用问卷和图表审查收集数据，包括处方药物的详细信息。使用 STOPP-J 和 Beers 标准将 PIM 和非 PIM 接受者进行分类。使用多变量 Cox 回归模型比较全因死亡率和首次住院情况。
STOPP-J 检测到 132 名患者（67.3%）存在 PIM，Beers 标准检测到 141 名患者（71.9%）存在 PIM，PIM 的平均数量分别为 1.3±1.3 和 1.2±1.1。STOPP-J 中最常开的三种 PIM 是催眠药（26.8%）、利尿剂（25.6%）和 NSAIDs（12.6%），而 Beers 标准中最常开的是质子泵抑制剂（PPIs）（29.8%）、催眠药（26%）和 NSAIDs（8.1%）。STOPP-J PIM 与全因死亡率（HR 3.01，95%CI 1.37-6.64）和住院（HR 1.91，95%CI 1.17-3.09）相关；Beers 标准的 PIM 与两者均无关。使用改良的 Beers 标准（不包括 PPIs），PIM 与首次住院相关（HR 1.91，95%CI 1.17-3.09）。
STOPP-J 分类的 PIM 与接受家庭医疗服务的日本患者的住院和死亡相关。常用于治疗酸相关疾病的 PPI 似乎对健康结果没有不良影响。针对特定国家和药物的标准将具有相当大的临床实用价值。
