Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University College of Pharmacy, Columbus, OH, USA.
SinfoníaRx: A TRHC Solution, Tucson, AZ, USA.
J Gen Intern Med. 2021 Aug;36(8):2346-2352. doi: 10.1007/s11606-020-06537-z. Epub 2021 Jan 27.
Potentially inappropriately prescribed medications (PIPMs) among patients with chronic kidney disease (CKD) may vary among clinical settings. Rates of PIPM are unknown among Medicare-enrolled Medication Therapy Management (MTM) eligible patients.
Determine prevalence of PIPM among patients with CKD and evaluate characteristics of patients and providers associated with PIPM.
An observational cross-sectional investigation of a Medicare insurance plan for the year 2018.
Medicare-enrolled MTM eligible patients with stage 3-5 CKD.
PIPM was identified utilizing a tertiary database. Logistic regression assessed relationship between patient characteristics and PIPM.
Investigation included 3624 CKD patients: 2856 (79%), 548 (15%), and 220 (6%) patients with stage 3, 4, and 5 CKD, respectively. Among patients with stage 3, stage 4, and stage 5 CKD, 618, 430, and 151 were with at least one PIPM, respectively. Logistic regression revealed patients with stage 4 or 5 CKD had 7-14 times the odds of having a PIPM in comparison to patients with stage 3 disease (p < 0.001). Regression also found PIPM was associated with increasing number of years qualified for MTM (odds ratio (OR) 1.46-1.74, p ≤ 0.005), female gender (OR 1.25, p = 0.008), and increasing polypharmacy (OR 1.30-1.57, p ≤ 0.01). Approximately 14% of all medications (2879/21093) were considered PIPM. Majority of PIPMs (62%) were prescribed by physician primary care providers (PCPs). Medications with the greatest percentage of PIPM were spironolactone, canagliflozin, sitagliptin, levetiracetam, alendronate, pregabalin, pravastatin, fenofibrate, metformin, gabapentin, famotidine, celecoxib, naproxen, meloxicam, rosuvastatin, diclofenac, and ibuprofen.
Over one-third of Medicare MTM eligible patients with CKD presented with at least one PIPM. Worsening renal function, length of MTM eligibility, female gender, and polypharmacy were associated with having PIPM. Majority of PIPMs were prescribed by PCPs. Clinical decision support tools may be considered to potentially reduce PIPM among Medicare MTM-enrolled patients with CKD.
慢性肾脏病（CKD）患者潜在的不适当处方药物（PIPM）可能因临床环境而异。医疗保险登记的药物治疗管理（MTM）合格患者中 PIPM 的发生率尚不清楚。
确定 CKD 患者中 PIPM 的流行率，并评估与 PIPM 相关的患者和提供者特征。
对 2018 年医疗保险计划的一项观察性横断面研究。
参加 MTM 的医疗保险登记合格患者，CKD 分期 3-5 期。
利用三级数据库确定 PIPM。Logistic 回归评估患者特征与 PIPM 之间的关系。
研究共纳入 3624 例 CKD 患者：分别为 2856（79%）、548（15%）和 220（6%）例 CKD 分期 3、4 和 5 期患者。在 CKD 分期 3、4 和 5 期的患者中，分别有 618、430 和 151 例患者至少有一种 PIPM。Logistic 回归显示，与 CKD 分期 3 期患者相比，CKD 分期 4 或 5 期患者发生 PIPM 的可能性是其 7-14 倍（p<0.001）。回归还发现，PIPM 与 MTM 合格年限的增加（优势比（OR）1.46-1.74，p≤0.005）、女性（OR 1.25，p=0.008）和多药治疗（OR 1.30-1.57，p≤0.01）有关。大约 14%的所有药物（2879/21093）被认为是 PIPM。大多数 PIPM（62%）是由医生初级保健提供者（PCP）开出的。PIPM 比例最高的药物是螺内酯、坎格列净、西他列汀、左乙拉西坦、阿伦膦酸钠、普伐他汀、非诺贝特、二甲双胍、加巴喷丁、法莫替丁、塞来昔布、萘普生、美洛昔康、瑞舒伐他汀、双氯芬酸和布洛芬。
超过三分之一的参加 MTM 的医疗保险登记的 CKD 患者至少有一种 PIPM。肾功能恶化、MTM 合格年限、女性和多药治疗与 PIPM 有关。大多数 PIPM 是由 PCP 开出的。临床决策支持工具可用于潜在减少医疗保险登记的 CKD 患者中的 PIPM。
