Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
BMJ Qual Saf. 2024 Nov 20;33(12):780-789. doi: 10.1136/bmjqs-2023-017042.
Polypharmacy is frequently used as a quality indicator for older adults in Residential Aged Care Facilities (RACFs) and is measured using a range of definitions. The impact of data source choice on polypharmacy rates and the implications for monitoring and benchmarking remain unclear. We aimed to determine polypharmacy rates (≥9 concurrent medicines) by using prescribed and administered data under various scenarios, leveraging electronic data from 30 RACFs.
A longitudinal cohort study of 5662 residents in New South Wales, Australia. Both prescribed and administered polypharmacy rates were calculated biweekly from January 2019 to September 2022, providing 156 assessment times. 12 different polypharmacy rates were computed separately using prescribing and administration data and incorporating different combinations of items: , and across four scenarios: no, 1-week, 2-week and 4-week look-back periods. Generalised estimating equation models were employed to identify predictors of discrepancies between prescribed and administered polypharmacy.
Polypharmacy rates among residents ranged from 33.9% using data on administered with no look-back period to 63.5% using prescribed with a 4-week look-back period. At each assessment time, the differences between prescribed and administered polypharmacy rates were consistently more than 10.0%, 4.5%, 3.5% and 3.0%, respectively, with no, 1-week, 2-week and 4-week look-back periods. Diabetic residents faced over two times the likelihood of polypharmacy discrepancies compared with counterparts, while dementia residents consistently showed reduced likelihood across all analyses.
We found notable discrepancies between polypharmacy rates for prescribed and administered medicines. We recommend a review of the guidance for calculating and interpreting polypharmacy for national quality indicator programmes to ensure consistent measurement and meaningful reporting.
在养老院中，通常使用多重用药来衡量老年人的医疗质量，并且有多种定义。选择数据源对多重用药率的影响以及对监测和基准测试的影响尚不清楚。我们旨在通过利用 30 家养老院的电子数据，根据各种情况使用规定的和管理的药物数据来确定多重用药率（≥9 种同时使用的药物）。
这是一项在澳大利亚新南威尔士州的 5662 名居民中进行的纵向队列研究。从 2019 年 1 月到 2022 年 9 月，每隔两周计算一次规定的和管理的多重用药率，共进行了 156 次评估。使用规定的和管理的数据，结合不同的项目组合（、和），分别计算了 12 种不同的多重用药率，并纳入了四种情况：不回溯期、1 周回溯期、2 周回溯期和 4 周回溯期。使用广义估计方程模型来确定规定的和管理的多重用药之间差异的预测因素。
居民的多重用药率从使用无回溯期的管理数据的 33.9%到使用 4 周回溯期的规定数据的 63.5%不等。在每次评估时，规定的和管理的多重用药率之间的差异始终超过 10.0%、4.5%、3.5%和 3.0%，分别对应无回溯期、1 周回溯期、2 周回溯期和 4 周回溯期。与对照组相比，患有糖尿病的居民发生多重用药差异的可能性高出两倍以上，而痴呆症患者在所有分析中始终显示出降低的可能性。
我们发现规定的和管理的药物多重用药率之间存在显著差异。我们建议重新审查用于计算和解释国家质量指标计划中的多重用药的指南，以确保一致的测量和有意义的报告。
