运用明确标准对老年患者入院时和住院期间的处方进行适宜性评估的循证应用。
Evidence-based application of explicit criteria to assess the appropriateness of geriatric prescriptions at admission and hospital stay.
机构信息
Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.
出版信息
PLoS One. 2020 Aug 25;15(8):e0238064. doi: 10.1371/journal.pone.0238064. eCollection 2020.
BACKGROUND
Inappropriate prescribing in the elderly is a critical issue in primary care, causing a higher risk of Adverse Drug Reactions (ADRs) and resulting in major patient safety concerns. At international level, many tools have been developed to identify Potentially Inappropriate Medications (PIMs).
OBJECTIVE
The aim of this study was the application of Beers, Screening Tool of Older People's Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) and Improving Prescribing in the Elderly Tool (IPET) criteria as key tool to improve the quality of prescribing.
METHODS
A retrospective study was conducted using the aforementioned criteria. Two different cohorts of elderly patients were enrolled between January 2015 and December 2016, 1800 at admission and 1466 at hospital stay. The index of each criterion divided by politherapy were correlated with comorbidities (Pearson correlation). A comparison was made between admission and hospital stay through a Student's t test of the average of the index.
RESULTS
The Proton Pump Inhibitors (PPIs) were the most prescribed PIMs according Beers criteria in both patient cohorts (56%). The most detected drug-drug and drug-disease interactions at admission and at hospital stay were 3 or more drugs active on the Central Nervous System (CNS) as they can predispose to fall-risk. The most detected PIMs with STOPP criteria at admission were PPIs administered for more than 8 weeks. Inhaled β2-agonists or antimuscarinics were the most prescribed Potential Prescription Omissions (PPOs) according to START criteria. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in patients with high blood pressure were the most detected PIMs according to IPET criteria during hospital stay. A significant correlation between the comorbidities and the all index at hospital stay, while at admission there was no significant correlation for Beers and IPET index.
CONCLUSION
The prescriptive criteria were a useful tool for assessing the quality of prescriptions in the geriatric population and identifying their critical issues.
背景
老年人用药不当是基层医疗中的一个关键问题，会增加药物不良反应（ADR）的风险，并导致严重的患者安全问题。在国际层面上，已经开发出许多工具来识别潜在不适当的药物（PIMs）。
目的
本研究旨在应用 Beers、老年人用药筛查工具（STOPP）/正确治疗警示筛查工具（START）和老年人用药改进工具（IPET）标准作为提高处方质量的关键工具。
方法
采用回顾性研究方法，应用上述标准纳入 2015 年 1 月至 2016 年 12 月期间入院和住院的两组不同老年患者，分别为 1800 例和 1466 例。每个标准的指数除以多药治疗与合并症相关（皮尔逊相关）。通过入院和住院期间指数平均值的学生 t 检验进行比较。
结果
根据 Beers 标准，质子泵抑制剂（PPIs）是两组患者中最常开的 PIMs（56%）。入院和住院期间检测到最多的药物-药物和药物-疾病相互作用是 3 种或更多作用于中枢神经系统（CNS）的活性药物，因为它们可能导致跌倒风险。入院时根据 STOPP 标准检测到最多的 PIMs 是使用超过 8 周的 PPI。根据 START 标准，最常开的潜在处方遗漏（PPO）是吸入β2-激动剂或抗毒蕈碱药物。根据 IPET 标准，住院期间高血压患者使用非甾体抗炎药（NSAIDs）是检测到最多的 PIMs。住院期间所有指数与合并症之间存在显著相关性，而入院时 Beers 和 IPET 指数与合并症之间无显著相关性。
结论
处方标准是评估老年人群处方质量和确定其关键问题的有用工具。
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