Abraham Danielle S, Pham Nguyen Thanh Phuong, Hennessy Sean, Weintraub Daniel, Gray Shelly L, Xie Dawei, Willis Allison W
Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Age Ageing. 2020 Aug 24;49(5):786-792. doi: 10.1093/ageing/afaa033.
impairments in neurotransmitter pathways put Parkinson's disease (PD) patients at risk for drug-disease interactions and adverse medication events.
to determine the prevalence and risk factors for potentially inappropriate medication (PIM) prescriptions, as defined by the 2015 Beers List, in PD.
cross-sectional analysis was conducted on 2014 Medicare beneficiaries with PD who had parts A, B and D coverage. The prevalence of PIM prescriptions for older adults was determined overall, and specifically for medications that can exacerbate motor symptoms or cognitive impairment in PD. Logistic regression models were constructed to determine the association between age, sex, race, geography and poverty with PIM prescriptions.
the final sample included 458,086 beneficiaries. In 2014, 35.8% of beneficiaries with PD filled a prescription for at least one PIM for older adults. In total, 8.7% of beneficiaries received a PIM that could exacerbate motor symptoms and 29.0% received a PIM that could worsen cognitive impairment. After adjustment, in all models, beneficiaries who were younger, female, white, urban-dwelling and eligible for Medicaid benefits were more likely to receive a PIM.
PIM prescriptions are not uncommon in PD, particularly for medications that can exacerbate cognitive impairment. Future research will examine underlying drivers of sex and other disparities in PIM prescribing. Additional studies are needed to understand the impact of PIMs on disease symptoms, healthcare utilisation and patient outcomes.
神经递质通路受损使帕金森病（PD）患者面临药物-疾病相互作用和不良药物事件的风险。
确定按照2015年《Beers标准》定义的帕金森病中潜在不适当用药（PIM）处方的患病率及危险因素。
对2014年享有A、B和D部分医保覆盖的帕金森病医疗保险受益人进行横断面分析。总体确定老年人PIM处方的患病率，尤其针对那些可加重帕金森病运动症状或认知障碍的药物。构建逻辑回归模型以确定年龄、性别、种族、地理位置和贫困状况与PIM处方之间的关联。
最终样本包括458,086名受益人。2014年，35.8%的帕金森病受益人至少开具了一种针对老年人的PIM处方。总体而言，8.7%的受益人接受了可能加重运动症状的PIM，29.0%的受益人接受了可能使认知障碍恶化的PIM。调整后，在所有模型中，年龄较小、女性、白人、居住在城市且符合医疗补助条件的受益人更有可能接受PIM。
PIM处方在帕金森病中并不罕见，尤其是对于那些可加重认知障碍的药物。未来研究将探讨PIM处方中性别差异及其他差异的潜在驱动因素。还需要更多研究来了解PIM对疾病症状、医疗保健利用和患者结局的影响。
