Guillot Jordan, Maumus-Robert Sandy, Marceron Alexandre, Noize Pernelle, Pariente Antoine, Bezin Julien
INSERM U1219, Bordeaux Population Health, Team Pharmacoepidemiology, University of Bordeaux, F-33000 Bordeaux, France.
Service de Pharmacologie Médicale, Pôle de Santé Publique, CHU de Bordeaux, 33000 Bordeaux, France.
J Clin Med. 2020 Nov 20;9(11):3728. doi: 10.3390/jcm9113728.
We aimed to describe the burden represented by potentially inappropriate medications (PIMs) in chronic polypharmacy in France. We conducted a nationwide cross-sectional study using data from the French National Insurance databases. The study period was from 1 January 2016 to 31 December 2016. Chronic drug use was defined as uninterrupted daily use lasting ≥6 months. Chronic polypharmacy was defined as the chronic use of ≥5 medications, and chronic hyperpolypharmacy as the chronic use of ≥10 medications. For individuals aged ≥65 (older adults), PIMs were defined according to the Beers and Laroche lists, and for individuals aged 45-64 years (middle-aged) PIMs were defined according to the PROMPT (Prescribing Optimally in Middle-aged People's Treatments) list. Among individuals with chronic polypharmacy, 4009 (46.2%) middle-aged and 18,036 (64.8%) older adults had at least one chronic PIM. Among individuals with chronic hyperpolypharmacy, these figures were, respectively, 570 (75.0%) and 2544 (88.7%). The most frequent chronic PIM were proton pump inhibitors (43.4% of older adults with chronic polypharmacy), short-acting benzodiazepines (older adults: 13.7%; middle-aged: 16.1%), hypnotics (6.1%; 7.4%), and long-acting sulfonylureas (3.9%; 12.3%). The burden of chronic PIM appeared to be very high in our study, concerning almost half of middle-aged adults and two-thirds of older adults with chronic polypharmacy. Deprescribing interventions in polypharmacy should primarily target proton pump inhibitors and hypnotics.
我们旨在描述法国慢性多重用药中潜在不适当用药（PIMs）所带来的负担。我们利用法国国家保险数据库的数据进行了一项全国性横断面研究。研究期间为2016年1月1日至2016年12月31日。慢性药物使用定义为持续≥6个月的每日不间断使用。慢性多重用药定义为慢性使用≥5种药物，慢性超多重用药定义为慢性使用≥10种药物。对于年龄≥65岁的个体（老年人），PIMs根据Beers和Laroche清单定义，对于年龄在45 - 64岁的个体（中年人），PIMs根据PROMPT（中年人的最佳处方治疗）清单定义。在患有慢性多重用药的个体中，4009名（46.2%）中年人以及18036名（64.8%）老年人至少有一种慢性PIM。在患有慢性超多重用药的个体中，这些数字分别为570名（75.0%）和2544名（88.7%）。最常见的慢性PIM是质子泵抑制剂（慢性多重用药的老年人中占43.4%）、短效苯二氮䓬类药物（老年人：13.7%；中年人：16.1%）、催眠药（6.1%；7.4%）和长效磺脲类药物（3.9%；12.3%）。在我们的研究中，慢性PIM的负担似乎非常高，涉及近一半患有慢性多重用药的中年成年人和三分之二的老年成年人。多重用药中的减药干预应主要针对质子泵抑制剂和催眠药。
