The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
BMC Geriatr. 2021 Jun 21;21(1):379. doi: 10.1186/s12877-021-02324-5.
The Hong Kong-specific criteria have been established in 2019 to assess potentially inappropriate medication (PIM) use in older adults and improve the local prescribing quality. The aim of this study was to compare the adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing the prevalence and correlates of PIM use in Hong Kong older patients.
A cross-sectional study was performed from January 1, 2014 to December 31, 2014 using the Hospital Authority (HA) database. A total of 489,301 older patients aged 65 years and older visiting general outpatient clinics (GOPCs) during the study period were included in the study. Two categories of PIM use included in the Hong Kong-specific criteria and 2015 Beers criteria, i.e. PIMs independent of diagnoses and PIMs considering specific medical conditions, were adapted to assess the prevalence of PIM use among the study sample. Characteristics of PIM users and the most frequently prescribed PIMs were investigated for each set of the criteria. Factors associated with PIM use were identified using the stepwise multivariable logistic regression analysis.
The adaptive Hong Kong-specific criteria could detect a higher prevalence of patients exposed to at least one PIM than that assessed by the adaptive Beers criteria (49.5% vs 47.5%). Meanwhile, the adaptive Hong Kong-specific criteria could identify a higher rate of patients exposed to PIMs independent of diagnoses (48.1% vs 46.8%) and PIMs considering specific medical conditions (7.3% vs 4.9%) compared with that of the adaptive Beers criteria. The most frequently prescribed PIMs detected by the adaptive Beers criteria were all included in the adaptive Hong Kong-specific criteria. The strongest factor associated with PIM use was number of different medications prescribed. Patients with female gender, aged 65 ~ 74 years, a larger number of GOPC visits, and more than six diagnoses were associated with greater risk of PIM use, whereas advancing age was associated with lower risk of PIM use.
The adaptive Hong Kong-specific criteria could detect a higher prevalence of PIM use than the adaptive Beers criteria in older adults visiting GOPCs in Hong Kong. It is necessary to update the prevalence and correlates of PIM use regularly in older adults to monitor the burden of PIM use and identify vulnerable patients who need further interventions.
香港特有的标准于 2019 年建立，用于评估老年人中潜在不适当的药物使用，并提高当地的处方质量。本研究的目的是比较香港特有的标准和 2015 年 Beers 标准的适应性版本，以评估香港老年患者中潜在不适当药物使用的流行率和相关因素。
本研究采用回顾性队列研究，使用医院管理局（HA）数据库，时间为 2014 年 1 月 1 日至 2014 年 12 月 31 日。共纳入研究期间年龄在 65 岁及以上、就诊于普通门诊（GOPC）的 489301 例老年患者。香港特有的标准和 2015 年 Beers 标准中包含的两类潜在不适当药物使用，即不考虑诊断的潜在不适当药物和考虑特定医疗条件的潜在不适当药物，被改编用于评估研究样本中潜在不适当药物使用的流行率。对每组标准中潜在不适当药物使用者的特征和最常开的潜在不适当药物进行了调查。使用逐步多变量逻辑回归分析确定与潜在不适当药物使用相关的因素。
适应性香港特有的标准比适应性 Beers 标准检测到的至少一种潜在不适当药物暴露的患者比例更高（49.5%比 47.5%）。同时，适应性香港特有的标准比适应性 Beers 标准能识别出更高比例的不考虑诊断的潜在不适当药物暴露（48.1%比 46.8%）和考虑特定医疗条件的潜在不适当药物暴露（7.3%比 4.9%）。适应性 Beers 标准检测到的最常开的潜在不适当药物都包含在适应性香港特有的标准中。与潜在不适当药物使用最相关的因素是开的不同药物的数量。女性、年龄 65~74 岁、就诊次数较多、诊断数较多的患者，使用潜在不适当药物的风险较高，而年龄较大的患者使用潜在不适当药物的风险较低。
适应性香港特有的标准比适应性 Beers 标准在评估香港 GOPC 就诊的老年患者中潜在不适当药物使用的流行率方面更有优势。有必要定期更新老年患者中潜在不适当药物使用的流行率和相关因素，以监测潜在不适当药物使用的负担，并识别需要进一步干预的脆弱患者。
