非随机药物使用关系表现为包含初级保健中老年多病患者处方药和非处方药的模式：多中心观察性队列研究 MultiCare 的探索性分析数据。

Non-random relations in drug use expressed as patterns comprising prescription and over-the-counter drugs in multimorbid elderly patients in primary care: Data of the exploratory analysis of the multicentre, observational cohort study MultiCare.

机构信息

Hospital Pharmacy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Eur J Gen Pract. 2021 Dec;27(1):119-129. doi: 10.1080/13814788.2021.1933425.

DOI:10.1080/13814788.2021.1933425

PMID:34132623

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8211130/

Abstract

BACKGROUND

The elderly population deals with multimorbidity (three chronic conditions) and increasinged drug use with age. A comprehensive characterisation of the medication - including prescription and over-the-counter (OTC) drugs - of elderly patients in primary care is still insufficient.

OBJECTIVES

This study aims to characterise the medication (prescription and OTC) of multimorbid elderly patients in primary care and living at home by identifying drug patterns to evaluate the relationship between drugs and drug groups and reveal associations with recently published multimorbidity clusters of the same cohort.

METHODS

MultiCare was a multicentre, prospective, observational cohort study of 3189 multimorbid patients aged 65 to 85 years in primary care in Germany. Patients and general practitioners were interviewed between 2008 and 2009. Drug patterns were identified using exploratory factor analysis. The relations between the drug patterns with the three multimorbidity clusters were analysed with Spearman-Rank-Correlation.

RESULTS

Patients (59.3% female) used in mean 7.7 drugs; in total 24,535 drugs (23.7% OTC) were detected. Five drug patterns for men (drugs for obstructive pulmonary diseases (D-OPD), drugs for coronary heart diseases and hypertension (D-CHD), drugs for osteoporosis (D-Osteo), drugs for heart failure and drugs for pain) and four drug patterns for women (D-Osteo, D-CHD, D-OPD and drugs for diuretics and gout) were detected. Significant associations between multimorbidity clusters and drug patterns were detectable (D-CHD and CMD: male: = 0.376, CI 0.322-0.430; female: = 0.301, CI 0.624-0.340).

CONCLUSION

The drug patterns demonstrate non-random relations in drug use in multimorbid elderly patients and systematic associations between drug patterns and multimorbidity clusters were found in primary care.

摘要

背景

老年人同时患有多种慢性疾病（三种慢性疾病），且随着年龄的增长，用药量也在增加。对初级保健中老年患者的药物治疗（包括处方药和非处方药）进行全面描述仍然不足。

目的

本研究旨在通过识别药物模式来描述初级保健中患有多种慢性疾病且居家的老年患者的药物治疗（处方药和非处方药）情况，评估药物与药物种类之间的关系，并揭示与同一队列中最近发表的多种慢性疾病聚类之间的关联。

方法

多关怀是一项多中心、前瞻性、观察性队列研究，共纳入德国初级保健机构中 3189 名年龄在 65 至 85 岁之间的患有多种慢性疾病的患者。患者和全科医生于 2008 年至 2009 年接受了访谈。使用探索性因子分析来识别药物模式。使用 Spearman-Rank-Correlation 分析药物模式与三种多种慢性疾病聚类之间的关系。

结果

患者（59.3%为女性）平均使用 7.7 种药物；共检测到 24535 种药物（23.7%为非处方药）。男性有 5 种药物模式（用于阻塞性肺病的药物（D-OPD）、用于冠心病和高血压的药物（D-CHD）、用于骨质疏松症的药物（D-Osteo）、用于心力衰竭的药物和用于疼痛的药物），女性有 4 种药物模式（D-Osteo、D-CHD、D-OPD 和用于利尿剂和痛风的药物）。可检测到多种慢性疾病聚类与药物模式之间存在显著相关性（D-CHD 和 CMD：男性： = 0.376，CI 0.322-0.430；女性： = 0.301，CI 0.624-0.340）。