Department of Medical and Clinical Pharmacology, Centre for Pharmacovigilance, PharmacoEpidemiology and Information on Medications, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France.
Fundam Clin Pharmacol. 2020 Dec;34(6):743-748. doi: 10.1111/fcp.12560. Epub 2020 May 17.
The PAAPI project (Optimising Inappropriate Prescriptions in the Elderly) is a multi-disciplinary approach put in place by the Toulouse Pharmacovigilance Centre (CRPV) in order to improve drug prescribing practice in nursing homes. The aim of this study was to analyse the association between polypharmacy, frequency of prescriptions for potentially inappropriate medications (PIMs) and the anticholinergic burden of prescriptions in elderly patients from the PAAPI cohort. We carried out a retrospective study on residents of 24 nursing homes (EHPAD) participating in the PAAPI programme between 1er January 2017 and 31 December. Resident's Data were collected in a single review in a random day. Drug prescriptions were analysed quantitatively and qualitatively. PIMs and anticholinergic drugs were identified by the list EU(7)PIM and the Duran scale, respectively. The total anticholinergic burden was calculated by adding the anticholinergic scores of each drug. We classified the drugs into three categories: no anticholinergic burden (burden = 0), low anticholinergic burden (≥1 ≤ 3) or high anticholinergic burden (burden > 3). A total of 1191 residents living were included, and we analysed 8869 drug prescription lines. The average age of the residents was 87.0 ± 8.3 years, and the majority (71.5%) were female. Nearly half of the residents (49.6%, n = 67) having a prescription with a high anticholinergic burden were taking more than 9 drugs (Fisher exact test P < 0.05). All the prescriptions with more than 5 PIMs (n = 23) had an anticholinergic burden > 0, with the majority (65.2%, n = 15) having a high anticholinergic burden (Kruskal-Wallis test, P < 0.0001). In this cohort, 88% (n = 539) of prescriptions with a low anticholinergic burden and 100% (n = 135) of prescriptions with a high anticholinergic burden included at least one PIM. According to our study, the anticholinergic burden of prescriptions given to residents in the PAAPI cohort is associated with the prescription of PIMs and with polypharmacy. Optimizing the use of medicines remains essential in this population, given the harmful properties of these drugs. It would also be useful for the list of anticholinergic drugs to be updated as new medicines come onto the market.
PAAPI 项目（优化老年人的不适当处方）是图卢兹药物警戒中心（CRPV）为改善养老院的药物处方实践而采取的多学科方法。本研究的目的是分析 PAAPI 队列中老年人的多药治疗、潜在不适当药物（PIM）处方的频率与处方的抗胆碱能负担之间的关系。我们对参加 PAAPI 计划的 24 家养老院（EHPAD）的居民进行了回顾性研究，时间为 2017 年 1 月 1 日至 12 月 31 日。在随机的一天对居民进行了一次回顾性数据收集。对药物处方进行了定量和定性分析。通过欧盟 7PIM 清单和 Duran 量表分别识别 PIM 和抗胆碱能药物。通过将每种药物的抗胆碱能评分相加来计算总抗胆碱能负担。我们将药物分为三类：无抗胆碱能负担（负担=0）、低抗胆碱能负担（≥1≤3）或高抗胆碱能负担（负担>3）。共纳入 1191 名居民，分析了 8869 条药物处方线。居民的平均年龄为 87.0±8.3 岁，其中大多数（71.5%）为女性。近一半（49.6%，n=67）有高抗胆碱能负担处方的居民服用了 9 种以上药物（Fisher 确切检验 P<0.05）。所有有超过 5 种 PIM 的处方（n=23）都有抗胆碱能负担>0，其中大多数（65.2%，n=15）有高抗胆碱能负担（Kruskal-Wallis 检验，P<0.0001）。在该队列中，88%（n=539）低抗胆碱能负担处方和 100%（n=135）高抗胆碱能负担处方都至少包含一种 PIM。根据我们的研究，PAAPI 队列中居民的处方抗胆碱能负担与 PIM 的处方和多药治疗有关。鉴于这些药物的有害特性，优化此类人群的药物使用仍然至关重要。随着新药上市，更新抗胆碱能药物清单也将非常有用。
