UnityPoint Health, Office of Research, Des Moines, IA, United States of America.; Des Moines University College of Osteopathic Medicine, Des Moines, IA, United States of America..
UnityPoint Health, Office of Research, Des Moines, IA, United States of America.; Des Moines University College of Osteopathic Medicine, Des Moines, IA, United States of America.
Am J Emerg Med. 2019 Sep;37(9):1734-1737. doi: 10.1016/j.ajem.2019.05.052. Epub 2019 May 28.
To investigate the frequency of Beers Criteria (BC) medication and opioid use in patients age 65 years and older arriving in the Emergency Department.
We performed a retrospective observational study of a convenience sample of 400 patients, age 65 years and older, arriving to and discharged solely from the Emergency Department. We examined 400 sequential patient charts with visit dates April-July 2017, for the presence of a Beers Criteria medication or opioid prescription. We also examined each chart for nine specific chief complaints, including return visits and subsequent admissions.
Of the 400 patients included in this study, 304 patients (76%; 95% confidence interval [CI] 72% to 80%) had at least 1 prescription at the index ED visit for an "avoid" or "use with caution" Beers Criteria medication. Of these patients, 194 (64%; 95% CI 58% to 69%) had ≥2 Beers medication prescriptions and 122 patients (40%; 95% CI 35% to 46%) had ≥3 Beers medication prescriptions. We found no difference in the number of patients with a chief complaint of interest between the BC medication list (28%) and lacking a BC medication (29%) (p-value = 1). No patients returned in the next 7 days for a medication-related complaint.
The results of this study call into question the routine application of lists without high-quality evidence to critique the prescribing of certain medications. Further patient-oriented study of the relevance of the Beers Criteria list, especially in light of the changed face of medication profiles and populations, is called for.
调查在 65 岁及以上年龄到达急诊部的患者中，使用 Beers 标准（BC）药物和阿片类药物的频率。
我们对 2017 年 4 月至 7 月期间，400 名年龄在 65 岁及以上，仅从急诊部就诊和出院的患者进行了一项回顾性观察性研究。我们检查了 400 名连续患者的病历，以确定是否存在 BC 药物或阿片类药物处方。我们还检查了每个病历的 9 个特定的主要症状，包括复诊和随后的入院。
在这项研究中，400 名患者中有 304 名（76%；95%置信区间 [CI] 72%至 80%）在首次就诊时至少有 1 种“避免”或“谨慎使用”BC 药物的处方。在这些患者中，194 名（64%；95%CI 58%至 69%）有≥2 种 BC 药物处方，122 名（40%；95%CI 35%至 46%）有≥3 种 BC 药物处方。我们发现，有兴趣的主要症状患者中，使用 BC 药物清单的患者数量（28%）与没有使用 BC 药物的患者数量（29%）之间没有差异（p 值=1）。没有患者在接下来的 7 天内因药物相关投诉而复诊。
这项研究的结果对在没有高质量证据的情况下，常规应用药物清单来批评某些药物的处方提出了质疑。需要进一步进行以患者为导向的研究，探讨 Beers 标准清单的相关性，特别是在药物概况和人群发生变化的情况下。
Zotero 插件