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使用 Beers 标准和 IFAsPIAM 清单评估阿根廷老年人潜在不适当药物的流行情况。

Prevalence of potentially inappropriate medications in older adults in Argentina using Beers criteria and the IFAsPIAM List.

机构信息

Área Farmacología, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, CONICET, Rosario, Argentina.

Atención Primaria de la Salud, Ministerio de Salud de la Provincia de Santa Fe, Rosario, Argentina.

出版信息

Int J Clin Pharm. 2019 Aug;41(4):913-919. doi: 10.1007/s11096-019-00858-8. Epub 2019 Jun 3.

Abstract

Background Medications in which the risk of adverse events exceeds the expectations of clinical benefits are called potentially inappropriate medications (PIMs). To identify the use of PIMs in elderly patients, the most commonly used tool are the Beers criteria, developed for the population of the United States. Recently, a consensus panel of Argentine experts developed the first Latin American tool, called the IFAsPIAM List. Objective The present study aimed to identify PIM prescriptions in elderly outpatients, to estimate the prevalence of PIMs, and to evaluate their possible relation with polypharmacy and gender and age of the patients. Also, we aimed to compare the results obtained by using the Beers criteria and the IFAsPIAM List. Setting Ten community pharmacies of Rosario, Santa Fe, Argentina. Methods A cross-sectional observational study was conducted between February and September 2015. Data were acquired from 56,952 prescriptions prescribed to 2231 patients aged 65 years old or older. To detect the use of PIMs, we used two tools: the Beers criteria and the IFAsPIAM List. Main outcome measure The prevalence of PIM use according to the Beers criteria and the IFAsPIAM List. Results The monthly average of medications dispensed per patient was 4.35 ± 2.18 and 42.27% of the patients presented major polypharmacy. The prevalence of PIMs was 72.75% according to the Beers criteria and 71.13% according to the IFAsPIAM List (Kappa coefficient k = 0.72), and was significantly higher in patients with major polypharmacy, older than 75 years old, and females. The most frequent PIMs prescribed were anxiolytics, analgesics and antipsychotics. Conclusions The IFAsPIAM List is an effective tool to evaluate the prescription of PIMs in the elderly. The results showed a high prevalence of PIMs with a multicausal origin and directly associated with polypharmacy. As clarified by the authors of the IFAsPIAM List, the criteria specified in the list do not substitute the clinical evaluation of each patient.

摘要

背景

与临床获益预期相比,风险超过的药物被称为潜在不适当药物(PIMs)。为了确定老年人中 PIM 的使用情况,最常用的工具是为美国人群开发的 Beers 标准。最近,阿根廷专家共识小组开发了第一个拉丁美洲工具,称为 IFAsPIAM 清单。目的:本研究旨在确定老年门诊患者的 PIM 处方,估计 PIM 的发生率,并评估其与多种药物治疗和患者的性别和年龄的可能关系。此外,我们旨在比较使用 Beers 标准和 IFAsPIAM 清单获得的结果。设置:阿根廷罗萨里奥的十家社区药房。方法:2015 年 2 月至 9 月期间进行了一项横断面观察性研究。从 2231 名 65 岁或以上的患者的 56952 张处方中获取数据。为了检测 PIM 的使用,我们使用了两种工具:Beers 标准和 IFAsPIAM 清单。主要观察指标:根据 Beers 标准和 IFAsPIAM 清单使用 PIM 的发生率。结果:每位患者每月平均配药 4.35 ± 2.18 种,42.27%的患者存在主要多重用药。根据 Beers 标准,PIM 的发生率为 72.75%,根据 IFAsPIAM 清单为 71.13%(Kappa 系数 k = 0.72),在多重用药、年龄大于 75 岁和女性患者中,PIM 的发生率显著更高。开处方最多的 PIM 是抗焦虑药、镇痛药和抗精神病药。结论:IFAsPIAM 清单是评估老年人 PIM 处方的有效工具。结果显示,PIM 的高发生率具有多因性,并与多种药物治疗直接相关。正如 IFAsPIAM 清单的作者所阐明的,清单中规定的标准不能替代对每位患者的临床评估。

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