University of Newcastle, Callaghan, NSW, Australia.
School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia.
Int J Pharm Pract. 2021 Dec 4;29(6):548-555. doi: 10.1093/ijpp/riab054.
Home Medicines Reviews (HMRs) can optimize medications for frail older adults. This study aimed to determine the use of HMRs according to frailty status and the association between frailty and use of HMRs.
The study included 9139 female participants enrolled in the Australian Longitudinal Study on Women's Health from 2003 (aged 77-82 years) to 2017 (aged 91-96 years). Generalized estimating equations (GEEs) using log-binomial regressions were used to determine associations using repeated measures on individuals over time.
The majority of participants in the study remained non-frail and did not receive HMRs from 2003 [7116 (77.86%)] to 2017 [1240 (71.31%)]. The use of HMRs was low in both groups with 33 (1.68%; 95% CI, 1.16 to 2.36) frail and 64 (0.89%; 95% CI, 0.69 to 1.14) non-frail participants receiving HMRs in 2003; by 2017, 19 (4.19%; 95% CI, 2.54 to 6.46) frail and 45 (3.50%; 95% CI, 2.57 to 4.66) non-frail participants received HMRs. Frailty was not associated with receiving a HMR (RR 1.06; 95% CI, 0.95 to 1.20), although for every 1-year increase, participants were 10% more likely to receive a HMR (RR 1.10; 95% CI, 1.09 to 1.11). Participants with continuous polypharmacy, ≥4 chronic diseases, >4 general practitioner visits and Department of Veterans Affairs coverage were more likely to receive a HMR.
Despite the proven value of HMRs for frail older people, HMRs were not used for most frail and non-frail community-dwelling women in this study. Reasons for low use of the service should be explored, with interventions to raise awareness of the benefits of the service.
家庭用药审查（HMR）可以优化体弱老年人的用药。本研究旨在根据虚弱状况确定 HMR 的使用情况，以及虚弱与 HMR 使用之间的关系。
该研究纳入了 2003 年（77-82 岁）至 2017 年（91-96 岁）参加澳大利亚女性健康纵向研究的 9139 名女性参与者。使用广义估计方程（GEE）对个体随时间进行重复测量，以对数二项式回归确定关联。
研究中大多数参与者在 2003 年至 2017 年期间保持非虚弱状态且未接受 HMR[7116（77.86%）]。两组 HMR 的使用均较低，2003 年有 33 名（1.68%；95%置信区间，1.16 至 2.36）虚弱参与者和 64 名（0.89%；95%置信区间，0.69 至 1.14）非虚弱参与者接受 HMR；到 2017 年，有 19 名（4.19%；95%置信区间，2.54 至 6.46）虚弱参与者和 45 名（3.50%；95%置信区间，2.57 至 4.66）非虚弱参与者接受 HMR。虚弱状况与接受 HMR 之间无关联（RR 1.06；95%置信区间，0.95 至 1.20），但参与者每增加 1 岁，接受 HMR 的可能性增加 10%（RR 1.10；95%置信区间，1.09 至 1.11）。持续服用多种药物、患有≥4 种慢性病、就诊次数≥4 次和退伍军人事务部覆盖范围的参与者更有可能接受 HMR。
尽管 HMR 对体弱老年人具有明显的价值，但在本研究中，大多数体弱和非体弱的社区居住女性并未使用 HMR。应探讨服务使用率低的原因，并采取措施提高对该服务益处的认识。
