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多病共存老年患者的多重用药:一项先导性 RCT 中观察到的患者与全科医生报告药物之间的一致性。

Polypharmacy in Older Patients with Multimorbidity: The Agreement Between Patient and General Practitioner-Reported Drugs Observed in a Pilot cRCT.

机构信息

Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.

Department of General Practice, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307 Dresden, Germany.

出版信息

Int J Environ Res Public Health. 2024 Oct 21;21(10):1389. doi: 10.3390/ijerph21101389.

Abstract

Polypharmacy (≥5 drugs) increases the risk of discrepancies between patient- and general practitioner (GP)-reported drugs, leading to adverse outcomes. This explorative analysis assesses the agreement between patient- and GP-reported drugs under the influence of a paper-based patient portfolio in a pilot cluster randomized controlled trial (cRCT). Complete data were available for 68 patients aged 65 or older (26 were female), with multimorbidity, polypharmacy, and at least one hospitalization in the past year. Agreement was assessed for drug name and strength level. Differences between the intervention and control group (IG/CG) and comparisons between two time points (six-month interval) stratified according to gender were analyzed using Wilcoxon and Mann-Whitney U tests (α = 5%). To evaluate the reasons for discrepancies, the agreement of active pharmaceutical ingredients (APIs) and anatomical therapeutic chemical (ATC) groups was analyzed. At baseline, the agreement was 72.1% for the IG and 73.9% for the CG. Inclusion of the reported drug strength reduced the agreement in both groups (IG 66.7%, CG 60.0%). Agreement for the IG decreased statistically significantly after six months (-5.4%). ATC groups B, C, and H had the highest agreement, while N, R, and Z had the lowest. Large discrepancies in the drugs reported, due to the APIs and the corresponding ATC group, were observed.

摘要

(药物)合用(≥5 种药物)增加了患者报告用药和全科医生(GP)报告用药之间差异的风险,从而导致不良后果。本探索性分析评估了纸质患者病历夹对试点群组随机对照试验(cRCT)中患者报告用药和 GP 报告用药之间的影响。共有 68 名年龄在 65 岁及以上(26 名为女性)、患有多种疾病、合并用药且过去一年至少住院一次的患者可提供完整数据。评估了药物名称和强度级别方面的一致性。使用 Wilcoxon 和 Mann-Whitney U 检验(α = 5%)分析了干预组和对照组(IG/CG)之间的差异以及根据性别分层的两个时间点(六个月间隔)之间的比较。为评估差异的原因,分析了活性药物成分(API)和解剖治疗化学(ATC)组的一致性。在基线时,IG 的一致性为 72.1%,CG 为 73.9%。两组的报告用药强度纳入后,一致性均降低(IG 为 66.7%,CG 为 60.0%)。六个月后,IG 的一致性呈统计学显著下降(-5.4%)。ATC 组 B、C 和 H 的一致性最高,而 N、R 和 Z 的一致性最低。由于 API 和相应的 ATC 组,报告的药物之间存在较大差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4d30/11508171/19f204c59817/ijerph-21-01389-g001.jpg

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