Research School of Population Health, Australian National University, Canberra, Sydney, Australia.
Sydney Pharmacy School and Centre for Education and Research on Ageing, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia.
BMJ Open. 2019 Feb 15;9(2):e027305. doi: 10.1136/bmjopen-2018-027305.
To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors.
Prospective cohort analysis.
SETTINGS, PARTICIPANTS, MEASUREMENTS: Questionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009-June 2014. Medication-related factors included exposure to five and more medications (polypharmacy), narrow therapeutic index medicines, potentially inappropriate prescribing defined using Beers Criteria medicines, and anticholinergic and sedative drugs, defined using the Drug Burden Index (DBI). Poisson and Cox regression models were used to evaluate HMR receipt in relation to sociodemographic, behavioural and health characteristics, and time-varying factors including medication use and hospitalisations.
HMR receipt during the 5-year study period.
Over 5 years of follow-up, 4.7% (n=6115) of 131 483 participants received at least one HMR. Five-year HMR receipt was: 1.5% in people using <5 medications at baseline, 6.8% with 5-9 medications, 12.7% with ≥10 medications, 8.8% using Narrow Therapeutic Index medicines, 6.8% using Beers Criteria potentially inappropriate medicines and 7.4% using DBI medicines. Age-sex stratified HRs for HMR receipt were 6.07 (95% CI: 5.58 to 6.59) and 12.46 (11.42 to 13.59) for concurrent use of 5-9 and ≥10 versus <5 medications, respectively. The age-sex adjusted rate ratio for HMR receipt was 2.65 (2.51 to 2.80) with poor versus good self-reported health; this association was attenuated substantially following additional adjustment for polypharmacy.
HMR was common in individuals using multiple medications, a formal indication for general practitioner referral and, to a lesser extent, with poorer health and other markers of high-risk prescribing. Despite this, HMR use over a 5-year period was generally below 10%, even in high-risk groups, suggesting substantial potential for improvement in uptake and targeting.
量化老年人接受家庭用药审查（HMR）与社会人口学、药物相关和健康因素之间的关系。
前瞻性队列分析。
地点、参与者、测量：来自澳大利亚悉尼的一项基于人群的≥45 岁个体队列研究的问卷调查数据与初级保健数据、药物和住院数据相关联，以确定 2009 年 7 月至 2014 年 6 月期间接受 HMR 的相关因素。药物相关因素包括使用五种或更多药物（多种药物）、治疗指数较窄的药物、使用 Beers 标准药物定义的潜在不适当处方以及使用药物负担指数（DBI）定义的抗胆碱能和镇静药物。泊松和 Cox 回归模型用于评估与社会人口学、行为和健康特征以及随时间变化的因素（包括药物使用和住院）相关的 HMR 接受情况。
在 5 年的研究期间接受 HMR。
在 5 年的随访中，131483 名参与者中有 4.7%（n=6115）至少接受了一次 HMR。5 年 HMR 接受率为：基线时使用<5 种药物者为 1.5%，使用 5-9 种药物者为 6.8%，使用≥10 种药物者为 12.7%，使用窄治疗指数药物者为 8.8%，使用 Beers 标准潜在不适当药物者为 6.8%，使用 DBI 药物者为 7.4%。5-9 种和≥10 种药物与<5 种药物同时使用的 HMR 接受年龄性别分层 HR 分别为 6.07（95%CI：5.58-6.59）和 12.46（11.42-13.59）。HMR 接受的年龄性别调整率比为 2.65（2.51-2.80），自我报告健康状况较差者为 2.65（2.51-2.80）；这种关联在进一步调整多种药物使用后大大减弱。
HMR 在使用多种药物的个体中很常见，这是全科医生转诊的一个正式指征，在一定程度上与较差的健康状况和其他高风险处方标志物有关。尽管如此，在 5 年期间，HMR 的使用率一般低于 10%，即使在高风险人群中也是如此，这表明在接受和目标方面有很大的改进潜力。
