Institute of General Practice and Public Health, College of Health Care Professions, Lorenz Böhler- Straße 13, 39100, Bolzano, Italy.
South Tyrolean Academy of General Practice, Wangergasse 18, 39100, Bolzano, Italy.
BMC Geriatr. 2021 Mar 20;21(1):197. doi: 10.1186/s12877-021-02141-w.
A precondition for developing strategies to reduce polypharmacy and its well-known harmful consequences is to study its epidemiology and associated factors. The objective of this study was to analyse the prevalence of polypharmacy (defined as ≥8 prescribed drugs), of potentially inappropriate medications (PIMs) and major drug-drug interactions (DDIs) among community-dwelling general practice patients aged ≥75 years and to identify characteristics being associated with polypharmacy.
This cross-sectional study is derived from baseline data (patients' demographic/biometric characteristics, diagnoses, medication-related data, cognitive/affective status, quality of life) of a northern-Italian cluster-RCT. PIMs and DDIs were assessed using the 2012 Beers criteria and the Lexi-Interact® database. Data were analysed using descriptive methods, Wilcoxon rank-sum tests, Fisher's exact tests and Spearman correlations.
Of the eligible patients aged 75+, 13.4% were on therapy with ≥8 drugs. Forty-three general practitioners and 579 patients participated in the study. Forty five point nine percent of patients were treated with ≥1 Beers-listed drugs. The most frequent PIMs were benzodiazepines/hypnotics (19.7% of patients) and NSAIDs (6.6%). Sixty seven point five percent of patients were exposed to ≥1 major DDI, 35.2% to ≥2 major DDIs. Antithrombotic/anticoagulant medications (30.4%) and antidepressants/antipsychotics (23.1%) were the most frequently interacting drugs. Polypharmacy was significantly associated with a higher number of major DDIs (Spearman's rho 0.33, p < 0.001) and chronic conditions (Spearman's rho 0.20, p < 0.001), higher 5-GDS scores (thus, lower affective status) (Spearman's rho 0.12, p = 0.003) and lower EQ-5D-5L scores (thus, lower quality of life) (Spearman's rho - 0.14, p = 0.001). Patients' age/sex, 6-CIT scores (cognitive status), BMI or PIM use were not correlated with the number of drugs.
The prevalence of polypharmacy, PIMs and major DDIs was considerable. Results indicate that physicians should particularly observe their patients with multiple conditions, reduced health and affective status, independently from other patients' characteristics. Careful attention about indication, benefit and potential risk should be paid especially to patients on therapy with specific drug classes identified as potentially inappropriate or prone to major DDIs in older persons (e.g., benzodiazepines, NSAIDs, protonic pump inhibitors, antithrombotics/anticoagulants, antidepressants/antipsychotics).
The cluster-RCT on which this cross-sectional analysis is based was registered with Current Controlled Trials Ltd. (ID ISRCTN: 38449870 ) on 2013-09-11.
制定减少多种用药及其已知有害后果的策略的前提条件是研究其流行病学和相关因素。本研究的目的是分析≥75 岁的社区居住的一般实践患者中多种用药（定义为≥8 种处方药）、潜在不适当药物（PIMs）和主要药物药物相互作用（DDIs）的流行情况，并确定与多种用药相关的特征。
本横断面研究源自意大利北部一项集群随机对照试验的基线数据（患者的人口统计学/生物统计学特征、诊断、药物相关数据、认知/情感状态、生活质量）。使用 2012 年 Beers 标准和 Lexi-Interact®数据库评估 PIMs 和 DDI。使用描述性方法、Wilcoxon 秩和检验、Fisher 确切检验和 Spearman 相关分析进行数据分析。
在符合条件的 75 岁及以上患者中，有 13.4%接受了≥8 种药物治疗。43 名全科医生和 579 名患者参与了这项研究。45.9%的患者接受了≥1 种被 Beers 列入清单的药物治疗。最常见的 PIMs 是苯二氮䓬/催眠药（19.7%的患者）和 NSAIDs（6.6%）。67.5%的患者暴露于≥1 种主要 DDI，35.2%的患者暴露于≥2 种主要 DDI。抗血栓/抗凝药物（30.4%）和抗抑郁药/抗精神病药（23.1%）是最常相互作用的药物。多种用药与更高数量的主要 DDI（Spearman's rho 0.33，p<0.001）和慢性疾病（Spearman's rho 0.20，p<0.001）显著相关，与 5-GDS 评分较高（即情感状态较低）（Spearman's rho 0.12，p=0.003）和 EQ-5D-5L 评分较低（即生活质量较低）（Spearman's rho-0.14，p=0.001）显著相关。患者的年龄/性别、6-CIT 评分（认知状态）、BMI 或 PIM 使用与药物数量无关。
多种用药、PIMs 和主要 DDI 的流行率相当高。结果表明，医生应特别关注有多种疾病、健康和情感状态下降的患者，而不论其他患者的特征如何。应特别注意特定药物类别的适应症、益处和潜在风险，特别是对接受被认为潜在不适当或易发生老年人主要 DDI 的药物（如苯二氮䓬、NSAIDs、质子泵抑制剂、抗血栓/抗凝药物、抗抑郁药/抗精神病药）治疗的患者。
本横断面分析所基于的集群 RCT 在 2013 年 9 月 11 日在 Current Controlled Trials Ltd.（ID ISRCTN：38449870）注册。
