Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
Cliniques Universitaires Saint-Luc, Pharmacy Department, Université Catholique de Louvain, Brussels, Belgium.
Drugs Aging. 2020 Dec;37(12):917-924. doi: 10.1007/s40266-020-00805-7. Epub 2020 Oct 13.
The STOPPFrail criteria were developed to assist physicians in deprescribing medications among frail patients approaching end of life. We aimed to measure the prevalence of potentially inappropriate medications (PIMs) and to describe changes over time, using STOPPFrail, in frail nursing home residents (NHRs) with limited life expectancy included in a medication review trial.
We conducted a post-hoc analysis of the COME-ON study, a cluster-controlled trial that evaluated the effect of a complex intervention on appropriateness of prescribing in Belgian nursing homes. We identified NHRs eligible for the application of STOPPFrail based on functional status, comorbidities, level of care and survival. PIM use was measured at baseline and at 8 months. Changes over time were compared in the control group (CG) and intervention group (IG).
At baseline, 308 NHRs met the STOPPFrail eligibility criteria, of whom 196 (64.1%) had one or more PIM. At 8 months, among the 218 NHRs who were alive, there was an absolute reduction in the prevalence of PIMs of 9.1% in the CG (p < 0.05) and 10.2% in the IG (p < 0.05). We found large reductions for some medications (e.g. proton pump inhibitors) but no reduction for others (e.g. calcium). The percentage of NHRs with one or more PIM discontinued without a new PIM initiated was higher in the IG than the CG but the difference was not significant (35.1% vs 23.6%, p = 0.127).
Among frail NHRs with poor survival prognosis, a significant and encouraging decrease in PIM prevalence over time was observed, probably facilitated by medication reviews. The overall prevalence of PIMs remained high, however.
STOPPFrail 标准旨在帮助医生为接近生命终点的体弱患者减少药物剂量。我们旨在使用 STOPPFrail 衡量预期寿命有限的体弱疗养院居民（NHR）中潜在不适当药物（PIM）的患病率，并描述随时间的变化，这些患者纳入了一项药物审查试验。
我们对 COME-ON 研究进行了事后分析，该研究是一项集群对照试验，评估了复杂干预措施对比利时疗养院适当处方的影响。我们根据功能状态、合并症、护理水平和生存情况，确定符合 STOPPFrail 应用标准的 NHR。在基线和 8 个月时测量 PIM 的使用情况。在对照组（CG）和干预组（IG）中比较随时间的变化。
在基线时，308 名 NHR 符合 STOPPFrail 入选标准，其中 196 名（64.1%）有 1 种或多种 PIM。在 8 个月时，在 218 名存活的 NHR 中，CG 中 PIM 的患病率绝对下降了 9.1%（p<0.05），IG 中下降了 10.2%（p<0.05）。我们发现某些药物（如质子泵抑制剂）的使用率大幅下降，但其他药物（如钙）没有下降。IG 中停止使用一种或多种 PIM 而未开始新的 PIM 的 NHR 比例高于 CG，但差异无统计学意义（35.1%比 23.6%，p=0.127）。
在预期寿命较差的体弱 NHR 中，随着时间的推移，PIM 的患病率显著且令人鼓舞地下降，这可能是药物审查的结果。然而，PIM 的总体患病率仍然很高。
