潜在不适当处方是否预示着住院和死亡风险增加？对“最年长老人”的纵向研究。
Does potentially inappropriate prescribing predict an increased risk of admission to hospital and mortality? A longitudinal study of the 'oldest old'.
机构信息
School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand.
出版信息
BMC Geriatr. 2020 Jan 28;20(1):28. doi: 10.1186/s12877-020-1432-4.
BACKGROUND
Potentially inappropriate prescribing (PIP) is associated with negative health outcomes, including hospitalisation and mortality. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is a longitudinal study of Māori (the indigenous population of New Zealand) and non-Māori octogenarians. Health disparities between indigenous and non-indigenous populations are prevalent internationally and engagement of indigenous populations in health research is necessary to understand and address these disparities. Using LiLACS NZ data, this study reports the association of PIP with hospitalisations and mortality prospectively over 36-months follow-up.
METHODS
PIP, from pharmacist applied criteria, was reported as potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). The association between PIP and hospitalisations (all-cause, cardiovascular disease-specific and ambulatory-sensitive) and mortality was determined throughout a series of 12-month follow-ups using binary logistic (hospitalisations) and Cox (mortality) regression analysis, reported as odds ratios (ORs) and hazard ratios (HRs), respectively, and the corresponding confidence intervals (CIs).
RESULTS
Full demographic data were obtained for 267 Māori and 404 non-Māori at baseline, 178 Māori and 332 non-Māori at 12-months, and 122 Māori and 281 non-Māori at 24-months. The prevalence of any PIP (i.e. ≥1 PIM and/or PPO) was 66, 75 and 72% for Māori at baseline, 12-months and 24-months, respectively. In non-Māori, the prevalence of any PIP was 62, 71 and 73% at baseline, 12-months and 24-months, respectively. At each time-point, there were more PPOs than PIMs; at baseline Māori were exposed to a significantly greater proportion of PPOs compared to non-Māori (p = 0.02). In Māori: PPOs were associated with a 1.5-fold increase in hospitalisations and mortality. In non-Māori, PIMs were associated with a double risk of mortality.
CONCLUSIONS
PIP was associated with an increased risk of hospitalisation and mortality in this cohort. Omissions appear more important for Māori in predicting hospitalisations, and PIMs were more important in non-Māori in predicting mortality. These results suggest understanding prescribing outcomes across and between population groups is needed and emphasises prescribing quality assessment is useful.
背景
潜在不适当处方（PIP）与负面健康结果相关，包括住院和死亡。《生命与老年：新西兰队列研究》（LiLACS NZ）是一项针对毛利人（新西兰的土著人口）和非毛利人 80 岁以上人群的纵向研究。国际上普遍存在土著人口和非土著人口之间的健康差距，因此有必要让土著人口参与健康研究，以了解和解决这些差距。本研究利用 LiLACS NZ 数据，前瞻性地报告了在 36 个月的随访期间 PIP 与住院和死亡的关联。
方法
根据药剂师应用的标准，报告了潜在不适当药物（PIMs）和潜在处方遗漏（PPOs）作为 PIP。通过一系列 12 个月的随访，使用二元逻辑（所有原因、心血管疾病特异性和门诊敏感）和 Cox（死亡率）回归分析，分别报告了 PIP 与住院（全因、心血管疾病特异性和门诊敏感）和死亡率之间的关联，结果表示为比值比（ORs）和风险比（HRs），并报告了相应的置信区间（CIs）。
结果
在基线时，267 名毛利人和 404 名非毛利人获得了完整的人口统计学数据，178 名毛利人和 332 名非毛利人在 12 个月时，122 名毛利人和 281 名非毛利人在 24 个月时。在基线、12 个月和 24 个月时，毛利人任何 PIP（即≥1 种 PIM 和/或 PPO）的患病率分别为 66%、75%和 72%。在非毛利人中，任何 PIP 的患病率分别为 62%、71%和 73%，在基线、12 个月和 24 个月时。在每个时间点，PPO 的数量都多于 PIM；在基线时，毛利人暴露于 PPO 的比例明显高于非毛利人（p=0.02）。在毛利人中，PPO 与住院和死亡的风险增加 1.5 倍相关。在非毛利人中，PIM 与死亡的风险增加一倍相关。
结论
在本队列中，PIP 与住院和死亡风险增加相关。遗漏在预测毛利人的住院方面似乎更为重要，而 PIM 在预测非毛利人的死亡方面更为重要。这些结果表明，需要了解跨人群和人群内的处方结果，并强调处方质量评估是有用的。
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