Vatcharavongvan Pasitpon, Puttawanchai Viwat
Department of Community Medicine and Family Medicine, Faculty of Medicine, Thammasat University. Pathum-Thani (Thailand).
Pharm Pract (Granada). 2019 Jul-Sep;17(3):1494. doi: 10.18549/PharmPract.2019.3.1494. Epub 2019 Aug 24.
The primary objective was to examine potentially inappropriate medications (or PIMs) in the elderly using three different criteria: Beers 2015, STOPP version 2, and Winit-Watjana (for Thai elderly patients). The secondary objective was to examine PIM-related factors.
This is a retrospective cross-sectional study. Eligible patients were aged ≥65 years in a primary care unit. Demographic data, medical prescriptions in the past year, clinical data and diagnoses were collected from electronic medical records. PIMs, including the use of ≥2 medications, were identified using the three criteria. Descriptive and analytical statistics were conducted. The type I error was 0.05. Multiple logistic regression analysis was used to examine associations between PIMs and other factors.
A total of 400 patients were recruited, and 1,640 prescriptions were reviewed. The median age was 70.5 years, and the median numbers of diseases, medications, and prescriptions were 3 (interquartile range or IQR=2), 11 (IQR=20), and 3 (IQR=4), respectively. Of all the patients, 213 (53.3%) showed a use of ≥5 medications, and 301 (75.3%) were prescribed PIMs. Of the 1,640 prescriptions, 60% had at least one PIM. The Winit-Watjana criteria, Beers 2015 criteria and STOPP version 2 identified 66.8%, 59.0% and 40.3% of the patients receiving PIMs, respectively. Approximately 16% of the patients showed at least one potential drug-drug interaction. The use of duplicate drug classes accounted for the highest proportion of potential drug-drug interactions (41.3%). Polypharmacy (odds ratio or OR 3.93, 95% confidence interval or 95%CI 2.17-71.2) and the presence of ≥4 diseases (OR 2.78, 95%CI 1.39-5.56) were associated with PIMs.
PIMs are common among the elderly patients in primary care in Thailand. Prescriptions of the elderly with polypharmacy or multiple concurrent diagnoses should be reviewed for PIMs because they have a high chance of receiving PIMs.
主要目的是使用三种不同标准检查老年患者中潜在不适当用药（PIMs）情况，这三种标准分别为《Beers 2015标准》、《STOPP第2版标准》以及Winit-Watjana标准（针对泰国老年患者）。次要目的是检查与PIMs相关的因素。
这是一项回顾性横断面研究。符合条件的患者为初级保健机构中年龄≥65岁的患者。从电子病历中收集人口统计学数据、过去一年的医疗处方、临床数据及诊断结果。使用这三种标准识别PIMs，包括使用≥2种药物的情况。进行描述性和分析性统计。I型错误设定为0.05。采用多元逻辑回归分析检查PIMs与其他因素之间的关联。
共招募400名患者，审查了1640份处方。中位年龄为70.5岁，疾病、药物及处方的中位数分别为3种（四分位间距或IQR = 2）、11种（IQR = 20）和3种（IQR = 4）。在所有患者中，213名（53.3%）使用了≥5种药物，301名（75.3%）被开具了PIMs。在1640份处方中，60%至少有一种PIM。Winit-Watjana标准、《Beers 2015标准》和《STOPP第2版标准》分别识别出接受PIMs的患者比例为66.8%、59.0%和40.3%。约16%的患者至少存在一种潜在药物相互作用。重复药物类别使用占潜在药物相互作用的比例最高（41.3%）。多重用药（优势比或OR 3.93，95%置信区间或95%CI 2.17 - 71.2）以及存在≥4种疾病（OR 2.78，95%CI 1.39 - 5.56）与PIMs相关。
在泰国初级保健机构的老年患者中，PIMs很常见。对于多重用药或同时患有多种疾病的老年患者的处方，应审查是否存在PIMs，因为他们接受PIMs的可能性很高。
