老年患者由初级保健医生进行药物减量：患病率和相关因素。

Deprescribing in older patients by early-career general practitioners: Prevalence and associations.

机构信息

Faculty of Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.

NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, NSW, Australia.

出版信息

Int J Clin Pract. 2021 Aug;75(8):e14325. doi: 10.1111/ijcp.14325. Epub 2021 May 24.

DOI:10.1111/ijcp.14325

PMID:33960089

Abstract

RATIONALE AND AIMS

Deprescribing is the health-professional-supervised process of withdrawal of an inappropriate medication to manage polypharmacy and improve patient outcomes. Given the harms of polypharmacy and associated inappropriate medicines, practitioners, especially general practitioners (GPs), are encouraged to take a proactive role in deprescribing in older patients. While trial evidence for benefits of deprescribing is accumulating, there is currently little epidemiologic evidence of clinicians' (including GPs') deprescribing behaviours. We aimed to establish the prevalence and explore associations of deprescribing of inappropriate medicines by early-career GPs.

METHODS

A cross-sectional analysis of the ReCEnT study of GP registrars' in-consultation experience, 2016-18. Participants recorded 60 consecutive consultations, three times at 6-month intervals, including medicines ceased (our measure of deprescribing). The outcome was deprescribing of an inappropriate medicine (defined by a synthesis of three accepted classification systems) in patients 65 years or older. Logistic regression determined the associations of deprescribing inappropriate medicines.

RESULTS

One thousand one hundred and thirteen registrars reported 19 581 consultations with patients 65 years and older. Inappropriate medicines were deprescribed in 2.6% (95% CIs 2.4%-2.9%) of consultations. Of deprescribed medicines, 43% had been prescribed for three months or longer. Most commonly deprescribed were opioids (19%), proton pump inhibitors (9.2%), anti-inflammatory drugs (9.0%), statins (7.8%), and antidepressants (6.6%). The most common reason for deprescribing was: "no longer indicated" (38%). Significant adjusted associations of deprescribing included patients identifying as Aboriginal or Torres Strait Islander (OR 2.86); continuity-of-care (ORs 0.71 and 0.20 for the patient being new to practice and to the registrar, respectively); inner-regional compared to major-city location (OR 1.33); the problem/diagnosis being chronic (OR 1.90); and longer consultations (OR 1.03 per minute increase in duration).

CONCLUSION

These findings will have important implications for the education of GPs in deprescribing as a clinical skill.

摘要

背景和目的

减药是一种由专业医疗人员监督的药物撤药过程，旨在管理多重用药并改善患者的治疗效果。鉴于多重用药的危害和相关的不当用药，鼓励医生，特别是全科医生（GP），在老年患者中积极参与减药。虽然减药的益处有临床试验证据支持，但目前关于临床医生（包括全科医生）减药行为的流行病学证据很少。我们旨在确定早期执业全科医生不当减药的流行程度并探讨其关联因素。

方法

这是对 2016-18 年 GP 住院医师在诊间经验的 ReCEnT 研究的横断面分析。参与者记录了 60 次连续就诊，每 6 个月记录 3 次，包括停止使用的药物（我们减药的衡量标准）。结局是在 65 岁及以上患者中停止使用一种不当药物（通过综合三种公认的分类系统定义）。Logistic 回归分析确定了不当药物减药的关联因素。

结果

1113 名住院医师报告了 19581 次 65 岁及以上患者的就诊。在 2.6%（95%CI 2.4%-2.9%）的就诊中，停止使用了不当药物。在停止使用的药物中，43%的药物已经使用了 3 个月或更长时间。最常被停用的药物是阿片类药物（19%）、质子泵抑制剂（9.2%）、非甾体抗炎药（9.0%）、他汀类药物（7.8%）和抗抑郁药（6.6%）。最常见的减药原因是“不再适用”（38%）。显著调整后的减药关联因素包括患者为原住民或托雷斯海峡岛民（OR 2.86）；连续医疗（患者对医生和诊所均为首次就诊时，OR 分别为 0.71 和 0.20）；与主要城市相比，内城区位置（OR 1.33）；问题/诊断为慢性疾病（OR 1.90）；以及就诊时间延长（每次就诊增加 1 分钟，OR 增加 1.03）。