2000 年和 2016 年挪威三家养老院精神药物不适当处方的回顾性比较与处方质量指标。
A retrospective comparison of inappropriate prescribing of psychotropics in three Norwegian nursing homes in 2000 and 2016 with prescribing quality indicators.
机构信息
Department of Clinical Biochemistry and Pharmacology, Haukeland University Hospital, 5021, Bergen, Norway.
Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
出版信息
BMC Med Inform Decis Mak. 2019 May 29;19(1):102. doi: 10.1186/s12911-019-0821-0.
BACKGROUND
Inappropriate prescribing of psychotropics is a persistent and prevalent problem in nursing homes. The present study compared inappropriate prescribing of psychotropics in nursing homes 16 years apart with prescribing quality indicators. The purpose was to identify any change in inappropriate prescribing of relevance for medical informatics.
METHODS
Three Norwegian nursing homes were audited in 2000 and 2016 with regard to prescribing quality. Psychotropics among 386 patients in 2000, and 416 patients in 2016, included combinations of antidepressants, antipsychotics, anxiolytics-hypnotics, and antiepileptics. Prescribing quality indicators included psychotropic polypharmacy (defined as concurrent use of three or more psychotropics) and potential inappropriate psychotropic substances or combinations. Furthermore, potential clinically relevant psychotropic interactions were classified as pharmacodynamic or pharmacokinetic using an interaction database. The first ranked (most important) interaction in each patient was selected with the following importance of categories in the database; recommended action > documentation > severity. Three levels (from low to high) within each category were used for ranking.
RESULTS
From 2000 to 2016, psychotropic polypharmacy increased from 6.2 to 29.6%, potential inappropriate psychotropic substances was reduced from 17.9 to 11.3% and potential inappropriate psychotropic combinations increased from 7.8 to 27.9%. Changes in polypharmacy and combinations were predominantly associated with prescribing of anxiolytics-hypnotics. Sixty-three patients (16.3%) had psychotropic interactions in 2000 increasing to 146 patients (35.1%) in 2016. The increase in interactions was associated with prescribing of antidepressants. First ranked interactions, more than 60% of all interactions in both years, were increasingly pharmacodynamic, from 69.9 to 91.0%. Interactions in 2016 were associated with a lower level of recommended action and documentation, but not severity compared to 2000. The inappropriate prescribing of antipsychotics and antiepileptics was reduced in 2016 compared to 2000.
CONCLUSIONS
Using prescribing quality indicators we observed the importance of antidepressants and anxiolytics-hypnotics for inappropriate prescribing in 2016 while the role of antipsychotics and antiepileptics were reduced compared to 2000. A change to mainly pharmacodynamic interactions that lack good documentation was also observed. The present findings can be used for medical informatics-based approaches to address specific problems with prescribing, and prescribing quality indicators, in Norwegian nursing homes.
背景
精神药物的不适当处方是养老院中持续存在且普遍存在的问题。本研究通过比较 16 年前和现在的精神药物处方质量指标，来比较养老院中精神药物的不适当处方情况。目的是确定任何与医疗信息学相关的不适当处方变化。
方法
对 2000 年和 2016 年的 3 家挪威养老院的处方质量进行了评估。2000 年有 386 名患者，2016 年有 416 名患者，包括抗抑郁药、抗精神病药、抗焦虑药-催眠药和抗癫痫药的组合。处方质量指标包括精神药物的多药联用（定义为同时使用三种或更多种精神药物）和潜在不适当的精神药物物质或组合。此外，使用药物相互作用数据库将潜在的临床相关精神药物相互作用分类为药效学或药代动力学。每个患者的第一个被选的（最重要的）相互作用是根据数据库中类别的重要性来选择的；推荐的操作>文档>严重程度。每个类别都使用 3 个级别（从低到高）进行排序。
结果
从 2000 年到 2016 年，精神药物的多药联用从 6.2%增加到 29.6%，潜在不适当的精神药物物质从 17.9%减少到 11.3%，潜在不适当的精神药物组合从 7.8%增加到 27.9%。多药联用和组合的变化主要与抗焦虑药-催眠药的处方有关。2000 年有 63 名患者（16.3%）有精神药物相互作用，2016 年有 146 名患者（35.1%）。相互作用的增加与抗抑郁药的处方有关。在这两年中，超过 60%的所有相互作用都是药效学的，占比从 69.9%增加到 91.0%。与 2000 年相比，2016 年的相互作用与较低的推荐操作和记录水平相关，但与严重程度无关。与 2000 年相比，2016 年抗精神病药和抗癫痫药的不适当处方有所减少。
结论
使用处方质量指标，我们观察到在 2016 年，抗抑郁药和抗焦虑药-催眠药对抗精神病药和抗癫痫药的不适当处方的重要性，而抗精神病药和抗癫痫药的作用在 2000 年有所降低。我们还观察到，主要是药效学相互作用的变化，这些相互作用缺乏良好的记录。本研究结果可用于基于医疗信息学的方法来解决挪威养老院中特定的处方问题和处方质量指标。
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