Schneider Juliana, Algharably Engi Abd Elhady, Budnick Andrea, Wenzel Arlett, Dräger Dagmar, Kreutz Reinhold
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Sciences, Berlin, Germany.
Front Pharmacol. 2021 Jun 8;12:686990. doi: 10.3389/fphar.2021.686990. eCollection 2021.
To measure the extent of polypharmacy, multimorbidity and potential medication-related problems in elderly patients with chronic pain receiving home care. Data of 355 patients aged ≥65 years affected by chronic pain in home care who were enrolled in the study in Berlin, Germany, were analyzed. History of chronic diseases, diagnoses, medications including self-medication were collected for all patients. Multimorbidity was defined as the presence of ≥2 chronic conditions and levels were classified by the Charlson-Comorbidity-Index. Polypharmacy was defined as the concomitant intake of ≥5 medications. Potentially clinically relevant drug interactions were identified and evaluated; underuse of potentially useful medications as well as overprescription were also assessed. More than half of the patients (55.4%) had moderate to severe comorbidity levels. The median number of prescribed drugs was 9 (range 0-25) and polypharmacy was detected in 89.5% of the patients. Almost half of them (49.3%) were affected by excessive polypharmacy (≥10 prescribed drugs). Polypharmacy and excessive polypharmacy occurred at all levels of comorbidity. We detected 184 potentially relevant drug interactions in 120/353 (34.0%) patients and rated 57 (31.0%) of them as severe. Underprescription of oral anticoagulants was detected in 32.3% of patients with atrial fibrillation whereas potential overprescription of loop diuretics was observed in 15.5% of patients. Multimorbidity and polypharmacy are highly prevalent in elderly outpatients with chronic pain receiving home care. Medication-related problems that could impair safety of drug treatment in this population are resulting from potentially relevant drug interactions, overprescribing as well as underuse.
为了衡量接受家庭护理的慢性疼痛老年患者的多重用药、多种疾病并存情况以及潜在的药物相关问题。对德国柏林355名年龄≥65岁、接受家庭护理且患有慢性疼痛的患者的数据进行了分析。收集了所有患者的慢性病病史、诊断情况以及包括自我用药在内的用药情况。多种疾病并存被定义为存在≥2种慢性病，其程度根据查尔森合并症指数进行分类。多重用药被定义为同时服用≥5种药物。识别并评估了潜在的临床相关药物相互作用；还评估了潜在有用药物的使用不足以及处方过量的情况。超过一半的患者（55.4%）患有中度至重度合并症。处方药物的中位数为9种（范围0 - 25种），89.5%的患者存在多重用药情况。其中近一半（49.3%）受到过度多重用药（≥10种处方药物）的影响。多重用药和过度多重用药在所有合并症程度中均有发生。我们在120/353名（34.0%）患者中检测到184种潜在相关的药物相互作用，其中57种（31.0%）被评为严重。在房颤患者中，32.3%的患者口服抗凝剂处方不足，而在15.5%的患者中观察到袢利尿剂存在潜在的处方过量情况。多种疾病并存和多重用药在接受家庭护理的慢性疼痛老年门诊患者中非常普遍。该人群中可能损害药物治疗安全性的药物相关问题是由潜在相关的药物相互作用、处方过量以及使用不足导致的。
