Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2019 May;67(5):1023-1026. doi: 10.1111/jgs.15800. Epub 2019 Feb 12.
As originally defined, the term "prescribing cascade" describes a sequence of events that begins when an adverse drug event (ADE) occurs, is misinterpreted as a new medical condition, and a subsequent drug is then inadvertently prescribed to treat the new condition. We refine the definition to encompass both recognized and unrecognized ADEs because they can both contribute to problematic prescribing practices. In addition, we discuss that although prescribing cascades are most commonly viewed as problematic, they may be appropriate and therapeutically beneficial in certain clinical situations. We differentiate between appropriate and problematic prescribing cascades by adopting a similar approach to the framework proposed in the highly acclaimed King's Fund report Polypharmacy and Medicines Optimization. Practical considerations are also presented to aid clinicians in preventing the propagation of problematic prescribing cascades within their clinical practice. Providing new perspectives on the scope and appropriateness of the prescribing cascade concept is an important step in describing clinically relevant cascades and in encouraging safe prescribing practices. J Am Geriatr Soc 67:1023-1026, 2019.
最初定义时，“处方传递”一词描述了一系列事件的发生顺序，从药物不良事件 (ADE) 开始，被错误地解释为新的医疗状况，然后无意中开了后续药物来治疗新的状况。我们将定义加以完善，纳入了公认和未经认可的 ADE，因为它们都可能导致有问题的处方行为。此外，我们还讨论了尽管处方传递通常被认为是有问题的，但在某些临床情况下，它们可能是合适的，并且具有治疗益处。我们通过采用与广受赞誉的 King's Fund 报告《多种药物治疗和药物优化》中提出的框架类似的方法，对合适的和有问题的处方传递进行区分。还提出了实际考虑因素，以帮助临床医生防止在临床实践中出现有问题的处方传递。提供关于处方传递概念的范围和适宜性的新观点，是描述临床相关传递和鼓励安全处方行为的重要步骤。美国老年医学会杂志 67:1023-1026, 2019。
