Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany.
Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Pharmacoepidemiol Drug Saf. 2021 Sep;30(9):1258-1268. doi: 10.1002/pds.5310. Epub 2021 Jun 24.
The aim of this study was to analyze the epidemiology of polypharmacy in hospital psychiatry. Another aim was to investigate predictors of the number of drugs taken and the associated risks of drug-drug interactions and potentially inappropriate medications in the elderly.
Daily prescription data were obtained from a pharmacovigilance project sponsored by the Innovations Funds of the German Federal Joint Committee.
The study included 47 071 inpatient hospital cases from eight different study centers. The mean number of different drugs during the entire stay was 6.1 (psychotropic drugs = 2.7; others = 3.4). The mean number of drugs per day was 3.8 (psychotropic drugs = 1.6; others = 2.2). One third of cases received at least five different drugs per day on average during their hospital stay (polypharmacy). Fifty-one percent of patients received more than one psychotropic drug simultaneously. Hospital cases with polypharmacy were 18 years older (p < 0.001), more likely to be female (52% vs. 40%, p < 0.001) and had more comorbidities (5 vs. 2, p < 0.001) than hospital cases without polypharmacy. The risks of drug-drug interactions (OR = 3.7; 95% CI = 3.5-3.9) and potentially inappropriate medication use in the elderly (OR = 2.2; CI = 1.9-2.5) substantially increased in patients that received polypharmacy.
Polypharmacy is frequent in clinical care. The number of used drugs is a proven risk factor of adverse drug reactions due to drug-drug interactions and potentially inappropriate medication use in the elderly. The potential interactions and the specific pharmacokinetics and -dynamics of older patients should always be considered when multiple drugs are used.
本研究旨在分析医院精神科中多种药物治疗的流行病学。另一个目的是调查老年人服用药物数量的预测因素，以及药物-药物相互作用和潜在不适当药物的相关风险。
每日处方数据来自德国联邦联合委员会创新基金赞助的药物警戒项目。
本研究包括来自八个不同研究中心的 47071 例住院患者。整个住院期间使用的不同药物的平均数量为 6.1（精神药物=2.7；其他药物=3.4）。平均每日用药量为 3.8（精神药物=1.6；其他药物=2.2）。三分之一的病例在住院期间平均每天至少服用五种不同的药物（多种药物治疗）。51%的患者同时服用超过一种精神药物。接受多种药物治疗的住院病例比未接受多种药物治疗的住院病例年长 18 岁（p<0.001），更可能为女性（52%比 40%，p<0.001），且合并症更多（5 种比 2 种，p<0.001）。接受多种药物治疗的患者发生药物-药物相互作用的风险（OR=3.7；95%CI=3.5-3.9）和老年人潜在不适当药物使用的风险（OR=2.2；CI=1.9-2.5）显著增加。
在临床护理中，多种药物治疗很常见。使用的药物数量是药物-药物相互作用和老年人潜在不适当药物使用导致不良反应的已知危险因素。当使用多种药物时，应始终考虑潜在的相互作用以及老年患者的特定药代动力学和药效学。
