Pharmacy Department of Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Civil Aviation General Hospital Pharmaceutical Preparation Section, Beijing, China.
J Clin Pharm Ther. 2020 Dec;45(6):1405-1413. doi: 10.1111/jcpt.13237. Epub 2020 Aug 10.
The aim of this study was to compare the prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in elderly Chinese patients identified by the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) version 2 (v2) and version 1 (v1). The secondary objective was to analyse the risk factors associated with the PIMs/PPOs.
This was a retrospective cross-sectional study, and all patients were aged ≥65 years and discharged from internal medical wards of Beijing Chaoyang Hospital in December 2018. STOPP/START v2 and STOPP/START v1 were used to detect PIMs/PPOs. The concordance between the two versions was calculated using kappa tests. A logistic regression analysis was carried out to determine variables independently associated with PIM/PPO use.
In the 662 patients included, the median age was 73 years and 361 were male (54.53%). PIMs were present in 36.1% and 47.7% of participants according to the STOPP v1 and STOPP v2, respectively. The prevalence of PPOs was 42.0% and 64.2% according to the START v1 and START v2, respectively. Drug prescribed without indication was the most common item in PIMs, whereas ACEIs were the drugs most frequently involved with PPOs according to the STOPP/START v2. Two versions of the STOPP criteria indicated a moderate coherence, whereas two versions of the START criteria showed poor accordance. Age (OR 1.029, 1.004-1.054), gender (OR 1.536, 1.103-2.138) and the number of prescribed medications (<5: OR 1; 5-9: OR 2.503, 1.173-5.342; ≥10: OR 4.324, 2.204-9.235) were associated factors with PIMs identified by the STOPP v2, whereas PPOs identified by the START v2 were independently associated with age (OR 1.039, 1.012-1.066), activities of daily living (ADL) score (OR 2.713, 1.818-4.048), the number of prescribed medications (<5: OR 1; 5-9: OR 2.704, 1.524-4.795; ≥10: OR 3.075, 1.704-5.549) and Charlson Comorbidity Index (OR 1.302, 1.110-1.529).
This study showed a high prevalence of PIMs/PPOs in aged internal medical ward inpatients in China, which was associated with various correlates. The STOPP/START v2 had a higher detection rate than v1.
本研究旨在比较使用 STOPP/START 版本 2（v2）和版本 1（v1）筛查工具识别的老年中国患者中潜在不适当药物（PIMs）和潜在药物遗漏（PPOs）的患病率。次要目的是分析与 PIM/PPO 相关的危险因素。
这是一项回顾性横断面研究，所有患者年龄均≥65 岁，并于 2018 年 12 月从北京朝阳医院内科病房出院。使用 STOPP/START v2 和 STOPP/START v1 检测 PIM/PPOs。使用 Kappa 检验计算两种版本之间的一致性。进行逻辑回归分析以确定与 PIM/PPO 使用相关的独立变量。
在纳入的 662 名患者中，中位年龄为 73 岁，361 名男性（54.53%）。根据 STOPP v1 和 STOPP v2，分别有 36.1%和 47.7%的参与者存在 PIMs。根据 START v1 和 START v2，PPOs 的患病率分别为 42.0%和 64.2%。根据 STOPP/START v2，药物无指征使用是 PIM 中最常见的项目，而 ACEIs 是与 PPO 最相关的药物。两种版本的 STOPP 标准均显示出中等一致性，而两种版本的 START 标准显示出较差的一致性。年龄（OR 1.029，1.004-1.054）、性别（OR 1.536，1.103-2.138）和处方药物数量（<5：OR 1；5-9：OR 2.503，1.173-5.342；≥10：OR 4.324，2.204-9.235）是与 STOPP v2 识别的 PIM 相关的因素，而与 START v2 识别的 PPO 相关的因素是年龄（OR 1.039，1.012-1.066）、日常生活活动（ADL）评分（OR 2.713，1.818-4.048）、处方药物数量（<5：OR 1；5-9：OR 2.704，1.524-4.795；≥10：OR 3.075，1.704-5.549）和 Charlson 合并症指数（OR 1.302，1.110-1.529）。
本研究表明，中国老年内科住院患者中 PIM/PPO 的患病率较高，与多种因素相关。STOPP/START v2 的检测率高于 v1。
