Thomas Roger E, Nguyen Leonard T, Jackson Dave, Naugler Christopher
Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2L 2K8, Canada.
Data Analyst, Alberta Precision Laboratories, Alberta Health Services, Calgary, AB T2N 4N1, Canada.
Geriatrics (Basel). 2020 Jun 12;5(2):37. doi: 10.3390/geriatrics5020037.
Polypharmacy with "potentially inappropriate medications" (PIMs) and "potential prescribing omissions" (PPOs) are frequent among those 65 and older. We assessed PIMs and PPOs in a retrospective study of 82,935 patients ≥ 65 during their first admission in the period March 2013 through February 2018 to the four acute-care Calgary hospitals. We used the American Geriatric Society (AGS) and STOPP/START criteria to assess PIMs and PPOs. We computed odds ratios (ORs) for key outcomes of concern to patients, their families, and physicians, namely readmission and/or mortality within six months of discharge, and controlled for age, sex, numbers of medications, PIMs, and PPOs. For readmission, the adjusted OR for number of medications was 1.09 (1.09-1.09), for AGS PIMs 1.14 (1.13-1.14), for STOPP PIMs 1.15 (1.14-1.15), for START PPOs 1.04 (1.02-1.06), and for START PPOs correctly prescribed 1.16 (1.14-1.17). For mortality within 6 months of discharge, the adjusted OR for the number of medications was 1.02 (1.01-1.02), for STOPP PIMs 1.07 (1.06-1.08), for AGS PIMs 1.11 (1.10-1.12), for START PPOs 1.31 (1.27-1.34), and for START PPOs correctly prescribed 0.97 (0.94-0.99). Algorithm rule mining identified an 8.772 higher likelihood of mortality with the combination of STOPP medications of duplicate drugs from the same class, neuroleptics, and strong opioids compared to a random relationship, and a 2.358 higher likelihood of readmission for this same set of medications. Detailed discussions between patients, physicians, and pharmacists are needed to improve these outcomes.
在65岁及以上的人群中，使用“潜在不适当药物”（PIMs）和“潜在处方遗漏”（PPOs）的多重用药情况很常见。在一项回顾性研究中，我们评估了2013年3月至2018年2月期间首次入住卡尔加里四家急症医院的82935名65岁及以上患者的PIMs和PPOs。我们使用美国老年医学会（AGS）和STOPP/START标准来评估PIMs和PPOs。我们计算了患者、其家属和医生关注的关键结局的比值比（OR），即出院后六个月内的再入院和/或死亡率，并对年龄、性别、用药数量、PIMs和PPOs进行了控制。对于再入院，用药数量的调整后OR为1.09（1.09 - 1.09），AGS PIMs为1.14（1.13 - 1.14），STOPP PIMs为1.15（1.14 - 1.15），START PPOs为1.04（1.02 - 1.06），正确开具的START PPOs为1.16（1.14 - 1.17）。对于出院后6个月内的死亡率，用药数量的调整后OR为1.02（1.01 - 1.02），STOPP PIMs为1.07（1.06 - 1.08），AGS PIMs为1.11（1.10 - 1.12），START PPOs为1.31（1.27 - 1.34），正确开具的START PPOs为0.97（0.94 - 0.99）。算法规则挖掘发现，与随机关系相比，同一类重复药物、抗精神病药物和强效阿片类药物的STOPP药物组合导致死亡的可能性高8.772倍，而同一组药物导致再入院的可能性高2.358倍。需要患者、医生和药剂师之间进行详细讨论以改善这些结局。
