Jungo Katharina Tabea, Streit Sven, Lauffenburger Julie C
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Arch Gerontol Geriatr. 2021 Mar-Apr;93:104326. doi: 10.1016/j.archger.2020.104326. Epub 2020 Dec 20.
The utilization of potentially inappropriate medications (PIMs) in older adults can lead to adverse events and increased healthcare costs. Polypharmacy, the concurrent utilization of multiple medications, is common in older adults with multiple chronic conditions.
To investigate the utilization and costs of PIMs in multimorbid older adults with polypharmacy over time.
This retrospective cross-sectional study used linked Medicare claims and electronic health records from seven hospitals/medical centers in Massachusetts (2007-2014). Participants were ≥65 years old, had ≥2 chronic conditions (to define multimorbidity), and used drugs from ≥5 pharmaceutical classes for ≥90 days (to define polypharmacy). Chronic conditions were defined using the Chronic Conditions Indicator from the Agency for Health Research and Quality. PIMs were defined using the American Geriatrics Society 2019 version of the Beers criteria. We calculated the percentage of patients with ≥1 PIMs and the percentages of patients using different types of PIMs. We used logistic regression analyses to test the odds of taking ≥1 PIMs. We calculated mean costs spent on PIMs by dividing the costs spent on PIMs by the total medication cost.
≥69% of patients used ≥1 PIM. After adjusting for healthcare utilization, chronic conditions, medication intake, and demographic factors, female sex (2014: Odds ratio (OR)=1.27, 95%CI 1.25-1.30), age (2014: OR=0.92, 95%CI 0.90-0.93), and Hispanic ethnicity (2014: OR=1.41, 95%CI 1.27-1.56) were associated with PIM use. Gastrointestinal drugs and central nervous system drugs were the most commonly-used PIMs. In patients using ≥1 PIM, >10% of medication costs were spent on PIMs.
The utilization of PIMs in US older adults with multimorbidity and polypharmacy is high.
老年人使用潜在不适当药物（PIMs）可能导致不良事件并增加医疗成本。多重用药，即同时使用多种药物，在患有多种慢性病的老年人中很常见。
调查患有多种疾病且多重用药的老年患者随时间推移使用PIMs的情况及成本。
这项回顾性横断面研究使用了马萨诸塞州七家医院/医疗中心（2007 - 2014年）的医疗保险理赔数据和电子健康记录。参与者年龄≥65岁，患有≥2种慢性病（以定义多重疾病），并且使用≥5类药物≥90天（以定义多重用药）。慢性病使用卫生研究与质量机构的慢性病指标进行定义。PIMs使用美国老年医学会2019版《Beers标准》进行定义。我们计算了使用≥1种PIMs的患者百分比以及使用不同类型PIMs的患者百分比。我们使用逻辑回归分析来检验服用≥1种PIMs的几率。我们通过将PIMs花费的成本除以总药物成本来计算PIMs的平均花费成本。
≥69%的患者使用≥1种PIMs。在调整了医疗利用、慢性病、药物摄入和人口统计学因素后，女性（2014年：比值比（OR）=1.27，95%置信区间1.25 - 1.30）、年龄（2014年：OR = 0.92，95%置信区间0.90 - 0.93）和西班牙裔种族（2014年：OR = 1.41，95%置信区间1.27 - 1.56）与PIMs使用相关。胃肠道药物和中枢神经系统药物是最常用的PIMs。在使用≥1种PIMs的患者中，超过10%的药物成本用于PIMs。
在美国患有多种疾病且多重用药的老年人中，PIMs的使用率很高。
