印度尼西亚一家二级教学医院急诊科老年患者潜在不适当用药及用药复杂性的患病率和相关因素
Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia.
作者信息
Hamidah Khusnul Fitri, Rahmadi Mahardian, Meutia Farah, Kriswidyatomo Prihatma, Rahman Firman Suryadi, Izzah Zamrotul, Zulkarnain Bambang Subakti, Aminde Leopold N, Alderman Christopher Paul, Suprapti Budi
机构信息
Department of Pharmacy, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.
Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.
出版信息
Pharm Pract (Granada). 2022 Oct-Dec;20(4):2735. doi: 10.18549/PharmPract.2022.4.2735. Epub 2022 Nov 8.
BACKGROUND
Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED).
OBJECTIVE
To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED.
METHODS
A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January - June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively.
RESULTS
A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 - 58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 - 10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 - 3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 - 3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 - 2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 - 15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 - 14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 - 5.401) were associated with higher medication complexity.
CONCLUSION
In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity.
背景
老年人身体各器官功能逐渐衰退，体内药物的药代动力学和药效学发生变化，导致用药相关问题的风险增加。潜在不适当用药（PIMs）和用药复杂性是导致急诊科（ED）药物不良事件的关键因素。
目的
评估急诊科收治的老年患者中PIMs的患病率，并调查其风险因素以及用药复杂性。
方法
对2020年1月至6月在艾尔朗加大学教学医院急诊科收治的60岁以上患者进行回顾性观察研究。分别使用2019年美国老年医学会Beers标准®和用药方案复杂性指数（MRCI）来衡量PIMs和用药复杂性。
结果
共纳入1005例患者，其中55.0%（95%置信区间[CI]：52 - 58%）的患者至少接受了一种PIM。然而，为老年人开具的药物治疗具有较高的复杂性指数（平均MRCI 17.23 + 11.15）。多因素分析显示，使用多种药物（OR = 6.954；95% CI：4.617 - 10.476）、患有循环系统疾病（OR = 2.126；95% CI：1.166 - 3.876）、内分泌、营养和代谢疾病（OR = 1.924；95% CI：1.087 - 3.405）以及消化系统疾病（OR = 1.858；95% CI：1.214 - 2.842）的患者接受PIM处方的风险增加。同时，呼吸系统疾病（OR = 7.621；95% CI：2.833 - 15.150）、内分泌、营养和代谢疾病（OR = 6.601；95% CI：2.935 - 14.847）以及使用多种药物（OR = 4.373；95% CI：3.540 - 5.401）与更高的用药复杂性相关。
结论
在我们的研究中，每两名急诊科收治的老年患者中就有超过一名存在PIMs，并且观察到用药复杂性较高。内分泌、营养和代谢疾病是接受PIMs和用药复杂性高的主要风险因素。
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