McCarthy Caroline, Flood Michelle, Clyne Barbara, Smith Susan M, Wallace Emma, Boland Fiona, Moriarty Frank
HRB Centre for Primary Care Research, Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.
School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin 2, Ireland.
Int J Clin Pharm. 2023 Feb;45(1):191-200. doi: 10.1007/s11096-022-01497-2. Epub 2022 Nov 16.
Number of medicines and medicines appropriateness are often used as outcome measures to evaluate the effectiveness of deprescribing interventions.
The aim of this study was to evaluate changes in prescribing, potentially inappropriate prescriptions (PIP) and prescribing of low-value medicines in older people with multimorbidity and significant polypharmacy.
This study was a retrospective secondary analysis of prescription data from a cluster randomised controlled trial involving 404 participants aged ≥ 65 years and prescribed ≥ 15 repeat medicines from 51 different general practices. For this study, repeat medications at baseline and follow-up (~ 1 year later) were assigned Anatomical Therapeutic Classification (ATC) codes. Outcomes were the most commonly prescribed and potentially inappropriately prescribed drug groups, the most frequently discontinued or initiated drug groups and the number of changes per person between baseline and follow-up.
There were 7051 medicines prescribed to 404 participants at baseline. There was a median of 17 medicines (IQR 15-19) at baseline and 16 (IQR 14-19) at follow-up. PIP represented 17.1% of prescriptions at baseline and 15.7% (n = 6777) at follow-up. There were reductions in the prescription of most drug groups with the largest reduction in antiplatelet prescriptions. Considering medication discontinuations, initiations and switches, there was a median of five medication changes per person (range 0-30, IQR 3-9) by follow-up. There were 95 low-value prescriptions at baseline reducing to 78 at follow-up.
The number of medication changes per person was not reflected by summarising medication count at two time points, highlighting the complexity of prescribing for patients with polypharmacy. Frequent medication changes has potentially important implications for patients in terms of adherence and medication safety.
The SPPiRE trial was registered prospectively on the ISRCTN registry (ISRCTN12752680).
药物数量和药物合理性通常用作评估减药干预措施有效性的结果指标。
本研究旨在评估患有多种疾病且用药种类繁多的老年人在处方、潜在不适当处方（PIP）和低价值药物处方方面的变化。
本研究是对一项整群随机对照试验的处方数据进行的回顾性二次分析，该试验涉及404名年龄≥65岁且从51家不同全科诊所开具≥15种重复用药的参与者。在本研究中，对基线和随访（约1年后）时的重复用药分配解剖治疗学分类（ATC）代码。结果指标为最常开具和潜在不适当开具的药物组、最常停用或起始的药物组以及每人在基线和随访之间的变化数量。
基线时404名参与者共开具了7051种药物。基线时药物中位数为17种（四分位间距15 - 19），随访时为16种（四分位间距14 - 19）。PIP在基线时占处方的17.1%，随访时占15.7%（n = 6777）。大多数药物组的处方量减少，抗血小板药物处方量减少最多。考虑到药物停用、起始和换药情况，随访时每人药物变化的中位数为5次（范围0 - 30，四分位间距3 - 9）。基线时有95张低价值处方，随访时降至78张。
通过总结两个时间点的用药数量并不能反映每人的用药变化数量，这凸显了为多重用药患者开处方的复杂性。频繁的用药变化在依从性和用药安全性方面对患者可能具有重要影响。
SPPiRE试验已在ISRCTN注册中心（ISRCTN12752680）进行前瞻性注册。
