潜在不适当药物使用与养老院居民住院的相关性研究。
Potentially inappropriate medication use as predictors of hospitalization for residents in nursing home.
机构信息
College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
College of Pharmacy, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongsangbuk, 38541, Republic of Korea.
出版信息
BMC Geriatr. 2023 Aug 2;23(1):467. doi: 10.1186/s12877-023-04165-w.
BACKGROUND
Hospitalization of nursing home (NH) residents impose a significant healthcare burden. However, there is still a lack of information regarding the risk of hospitalization from inappropriate prescribing in NH residents. We aimed to estimate the nationwide prevalence of potentially inappropriate medication (PIM) use among NH residents using the Korean tool and 2019 Beers criteria and to assess their associations with hospitalization or emergency department (ED) visits.
METHODS
We included older adults aged 65 years or above who were admitted to NHs between July 2008 and December 2018 using national senior cohort database. The prevalence of PIM use based on the Korean medication review tool and Beers criteria on the date of admission to NH was estimated. And the adjusted hazard ratios (aHRs) of polypharmacy, numbers of PIM, each PIM category for hospitalization/ED visits within 30 days of admission to NH was calculated using Cox proportional hazard model to show the association.
RESULTS
Among 20,306 NH residents, the average number of medications per person was 7.5 ± 4.7. A total of 89.3% and 67.9% of the NH residents had at least one PIM based on the Korean tool and 2019 Beers criteria, respectively. The risk of ED visits or hospitalization significantly increased with the number of PIMs based on the Korean tool (1-3: aHR = 1.24, CI 1.03-1.49; ≥4: aHR = 1.46, CI 1.20-1.79). Having four or more PIMs based on the Beers criteria increased the risk significantly (aHR = 1.30, CI 1.06-1.53) while using 1-3 PIMs was not significantly associated (aHR = 1.07, CI 0.97-1.19). Residents with any potential medication omission according to the Korean criteria, were at 23% higher risk of hospitalization or ED visits (aHR = 1.23, CI 1.07-1.40).
CONCLUSIONS
This study demonstrated that PIMs, based on the Korean tool and Beers criteria, were prevalent among older adults living in NHs and the use of PIMs were associated with hospitalization or ED visits. The number of PIMs based on the Korean tool showed dose-response increase in the risk of hospitalization or ED visits.
背景
养老院（NH）居民住院会给医疗保健带来重大负担。然而，关于 NH 居民因不当处方而住院的风险，仍缺乏相关信息。我们旨在使用韩国工具和 2019 年 Beers 标准来估计全国 NH 居民中潜在不适当药物（PIM）使用的患病率，并评估它们与住院或急诊部（ED）就诊的关系。
方法
我们纳入了 2008 年 7 月至 2018 年 12 月期间使用全国老年人队列数据库入住 NH 的 65 岁及以上老年人。根据韩国药物审查工具和 Beers 标准，估计入院时 PIM 使用的患病率。并使用 Cox 比例风险模型计算多药治疗、PIM 数量、每种 PIM 类别与 NH 入院后 30 天内住院/ED 就诊的调整后风险比（aHR），以显示相关性。
结果
在 20306 名 NH 居民中，人均用药量为 7.5±4.7。根据韩国工具和 2019 年 Beers 标准，分别有 89.3%和 67.9%的 NH 居民至少有一种 PIM。根据韩国工具，ED 就诊或住院的风险随着 PIM 数量的增加而显著增加（1-3：aHR=1.24，CI 1.03-1.49；≥4：aHR=1.46，CI 1.20-1.79）。根据 Beers 标准，使用四种或更多 PIM 显著增加了风险（aHR=1.30，CI 1.06-1.53），而使用 1-3 种 PIM 则无显著相关性（aHR=1.07，CI 0.97-1.19）。根据韩国标准，任何潜在药物遗漏的居民住院或 ED 就诊的风险增加 23%（aHR=1.23，CI 1.07-1.40）。
结论
本研究表明，基于韩国工具和 Beers 标准的 PIM 在 NH 中老年人中很常见，并且 PIM 的使用与住院或 ED 就诊有关。基于韩国工具的 PIM 数量与住院或 ED 就诊风险呈剂量反应增加。
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