根据 STOPP-J 标准，潜在不适当药物治疗与接受居家医疗服务的老年患者住院和死亡风险的相关性。

Potentially inappropriate medications according to STOPP-J criteria and risks of hospitalization and mortality in elderly patients receiving home-based medical services.

机构信息

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.

出版信息

PLoS One. 2019 Feb 8;14(2):e0211947. doi: 10.1371/journal.pone.0211947. eCollection 2019.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

背景

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。

方法

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。

结果

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）。