Thomas Roger E, Nguyen Leonard T
Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
Data Analyst, Albert Precision Laboratories, Alberta Health Services, Calgary, AB T2N 4N1, Canada.
Geriatrics (Basel). 2020 Sep 30;5(4):68. doi: 10.3390/geriatrics5040068.
Key problems for seniors are their exposure to "potentially inappropriate medications" and "potential medication omissions", which place them at risk for moderate, severe, or fatal adverse drug reactions. This study of 82,935 first admissions to acute care hospitals in Calgary during 2013-2018 identified 294,160 Screening Tool of Older People's Prescriptions (STOPP) potentially inappropriate medications (PIMs) (3.55/patient), 226,970 American Geriatric Society (AGS) Beers PIMs (2.74/patient), 59,396 START potential prescribing omissions (PPOs) (0.72/patient), and 85,288 STOPP PPOs (1.03/patient) for which a new prescription corrected the omission. This represents an overwhelming workload to prevent inappropriate prescriptions continuing during the hospitalisation and then deprescribe them judiciously. Limiting scrutiny to the most frequent PIMs and PPOs will identify many moderate, severe, or fatal risks of causing adverse drug reactions (ADRs) but to identify all PIMs or PPO involving moderate or severe risks of ADRs also involves searching lower in the frequency list of patients. Deciding whether to use the STOPP or AGS Beers PIM lists is an important issue in searching for ADRs, because the Pearson correlation coefficient for agreement between the STOPP and AGS Beers PIM totals in this study was 0.7051 (95% CI 0.7016 to 0.7085; < 0.001). The combined lists include 289 individual PIM medications but STOPP and AGS have only 159 (55%) in common. The AGS Beers lists include medications used in the US and STOPP/START those used in Europe. The AGS authors recommend using both criteria. The ideal solution to the problem is to implement carefully constructed Clinical Decision Support Systems (CDSS) as in the SENATOR trial, then for an experienced pharmacist to focus on the key PIMs and PPOs likely to lead to moderate, severe, or fatal ADRs. The pharmacist and key decision makers on the services need to establish a collegial relationship to discuss frequently changing the medications that place the patients at risk. Then, the remaining PIMs and PPOs that relate to chronic disease management can be discussed by phone with the family physician using the discharge summary, which lists the medications for potential deprescribing.
老年人面临的关键问题是他们使用了“潜在不适当药物”以及存在“潜在用药遗漏”的情况，这使他们面临中度、重度或致命药物不良反应的风险。这项针对2013年至2018年期间卡尔加里82935例首次入住急症医院患者的研究发现了294160种老年人处方筛查工具（STOPP）潜在不适当药物（PIMs）（每位患者3.55种）、226970种美国老年医学会（AGS）Beers标准PIMs（每位患者2.74种）、59396种START潜在处方遗漏（PPOs）（每位患者0.72种）以及85288种STOPP PPOs（每位患者1.03种），针对这些遗漏，新处方进行了纠正。这代表着一项巨大的工作量，既要防止住院期间不适当处方的持续开具，又要明智地逐渐减少用药。将审查局限于最常见的PIMs和PPOs会识别出许多导致药物不良反应（ADR）的中度、重度或致命风险，但要识别所有涉及中度或重度ADR风险的PIMs或PPOs，还需要在患者频率列表中进一步查找。在寻找ADR时，决定使用STOPP还是AGS Beers PIM列表是一个重要问题，因为在本研究中，STOPP和AGS Beers PIM总数之间的皮尔逊相关系数为0.7051（95%置信区间0.7016至0.7085；P<0.001）。合并后的列表包括289种单独的PIM药物，但STOPP和AGS只有159种（55%）相同。AGS Beers列表包括在美国使用的药物，而STOPP/START列表包括在欧洲使用的药物。AGS的作者建议同时使用这两个标准。解决该问题的理想方案是像在参议员试验中那样实施精心构建的临床决策支持系统（CDSS），然后让经验丰富的药剂师专注于可能导致中度、重度或致命ADR的关键PIMs和PPOs。药剂师和服务中的关键决策者需要建立一种合作关系，经常讨论那些使患者处于风险中的药物的变化。然后，可以通过电话与家庭医生利用出院小结讨论与慢性病管理相关的其余PIMs和PPOs，出院小结列出了可能需要逐渐减少用药的药物。
