Petit-Monéger Aurélie, Jouhet Vianney, Thiessard Frantz, Berdaï Driss, Noize Pernelle, Gilleron Véronique, Caridade Guillaume, Salmi Louis-Rachid, Saillour-Glénisson Florence
CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France.
Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.
BMC Health Serv Res. 2019 Apr 30;19(1):272. doi: 10.1186/s12913-019-4064-7.
The appropriateness of psychotropic prescriptions in the elderly is a major quality-of-care challenge at hospital. Quality indicators have been developed to prevent inappropriate psychotropic prescriptions. We aimed to select and automatically calculate such indicators, from the Bordeaux University Hospital information system, and to analyze the appropriateness of psychotropic prescription practices, in an observational study.
Experts selected indicators of the appropriateness of psychotropic prescriptions in hospitalized elderly patients, according to guidelines from the French High Authority for Health. The indicators were reformulated to focus on psychotropic administrations. The automated calculation of indicators was analyzed by comparing their measure to data collected from a clinical audit. In elderly patients hospitalized between 2014 and 2015, we then analyzed the evolution of the appropriateness of psychotropic prescription practices during hospital stay, using methods of visualization, and described practices by considering patients' characteristics.
Two indicators were automated to detect overuse and misuse of psychotropic drugs. Indicators identified frequent inappropriate drug administrations, but practices tended to become more appropriate after quality-of-care improvement actions. In the majority of patients (85%), there was no inappropriate administration of psychotropic drugs during hospital stay; for the remaining 15% with at least one inappropriate administration, physicians tended to limit overuse or misuse during hospital stay. Inappropriate administrations were more frequent in patients suffering from psychiatric disorders, dependence and associated complications or morbidities.
The automated indicators are structuring tools for the development of a drug prescription monitoring system. Inappropriate psychotropic administrations were limited by physicians during hospital stay; some inappropriate prescriptions might be explained by clinical characteristics of patients.
老年人精神药物处方的合理性是医院护理质量面临的一项重大挑战。已制定质量指标以防止不适当的精神药物处方。在一项观察性研究中，我们旨在从波尔多大学医院信息系统中选择并自动计算此类指标，并分析精神药物处方实践的合理性。
专家根据法国卫生高级管理局的指南，选择了住院老年患者精神药物处方合理性的指标。对这些指标进行了重新表述，以关注精神药物的使用情况。通过将指标的测量结果与临床审计收集的数据进行比较，分析了指标的自动计算情况。然后，我们使用可视化方法分析了2014年至2015年住院的老年患者在住院期间精神药物处方实践合理性的变化情况，并根据患者特征描述了相关实践。
自动计算出两项指标，用于检测精神药物的过度使用和误用。这些指标识别出频繁的不适当药物使用情况，但在采取护理质量改进措施后，相关实践往往变得更加合理。在大多数患者（85%）中，住院期间没有不适当的精神药物使用情况；在其余15%至少有一次不适当使用情况的患者中，医生在住院期间倾向于限制过度使用或误用。在患有精神疾病、依赖及相关并发症或病症的患者中，不适当的使用情况更为频繁。
这些自动计算的指标是药物处方监测系统开发的结构化工具。医生在住院期间限制了不适当的精神药物使用；一些不适当的处方可能由患者的临床特征来解释。
