药物数量与潜在不适当多重用药指标之间的关联：加拿大魁北克省一个基于人群的老年人队列研究

Association between number of medications and indicators of potentially inappropriate polypharmacy: a population-based cohort of older adults in Quebec, Canada.

作者信息

Campeau Calfat Alexandre, Turner Justin P, Simard Marc, Boiteau Véronique, Sirois Caroline

机构信息

Faculty of Pharmacy, Université Laval, Québec, QC, Canada.

Institut national de santé publique du Québec, Québec, QC, Canada.

出版信息

Ther Adv Drug Saf. 2024 Dec 25;15:20420986241309882. doi: 10.1177/20420986241309882. eCollection 2024.

DOI:10.1177/20420986241309882

PMID:39737141

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11683794/

Abstract

BACKGROUND

As the number of medications increases, the appropriateness of polypharmacy may become questionable due to the heightened risk of medication-related harm.

OBJECTIVES

(1) To investigate the relationship between the number of current medications used by older adults and three indicators of potentially inappropriate polypharmacy: (a) the mean number of potentially inappropriate medications (PIMs), (b) the average count of drug-drug interactions, and (c) the anticholinergic burden; (2) To characterize the population-based burden of potentially inappropriate polypharmacy by calculating the proportion of individuals with these indicators.

DESIGN

We conducted a population-based observational study using the Quebec Integrated Chronic Disease Surveillance System.

METHODS

We included all individuals over 65 years insured by the public drug plan on April 1st, 2022. For each individual, we calculated the number of current medications and the number of (a) PIMs (Beers 2019), (b) drug-drug interactions (Beers 2019), and (c) anticholinergic burden (Anticholinergic Cognitive Burden (ACB) scale). The association between the number of medications and these indicators was quantified using linear regression. Prevalence with 99% confidence intervals (CIs) was calculated.

RESULTS

A total of 1,437,558 individuals (mean age: 75; 55% female) were included, taking an average of 4.9 medications (±4.1). For each additional medication, the mean number of PIMs, drug-drug interactions, and anticholinergic burden increased by 0.11, 0.04, and 0.17, respectively (-trend <0.0001). Nearly half the population (45.5%; 99% CI: 45.5-45.5) had a regimen containing ⩾1 PIMs, ⩾1 drug-drug interaction, or an ACB ⩾3.

CONCLUSION

The strong association between the increasing number of medications and reduced polypharmacy quality underscores the importance of medication count beyond therapeutic indications. With widespread medication use, many older adults face quality issues.

摘要

背景

随着药物数量的增加，由于用药相关伤害风险的提高，多重用药的合理性可能会受到质疑。

目的

（1）研究老年人当前使用的药物数量与潜在不适当多重用药的三个指标之间的关系：（a）潜在不适当药物（PIMs）的平均数量，（b）药物相互作用的平均计数，以及（c）抗胆碱能负担；（2）通过计算具有这些指标的个体比例来描述基于人群的潜在不适当多重用药负担。

设计

我们使用魁北克综合慢性病监测系统进行了一项基于人群的观察性研究。

方法

我们纳入了2022年4月1日由公共药物计划承保的所有65岁以上的个体。对于每个个体，我们计算了当前使用的药物数量以及（a）PIMs的数量（2019年版Beers标准），（b）药物相互作用的数量（2019年版Beers标准），以及（c）抗胆碱能负担（抗胆碱能认知负担（ACB）量表）。使用线性回归对药物数量与这些指标之间的关联进行量化。计算99%置信区间（CIs）的患病率。

结果

共纳入1,437,558名个体（平均年龄：75岁；55%为女性），平均服用4.9种药物（±4.1）。每增加一种药物，PIMs的平均数量、药物相互作用的数量和抗胆碱能负担分别增加0.11、0.04和0.17（-趋势<0.0001）。近一半的人群（45.5%；99%CI：45.5 - 45.5）的用药方案中含有≥1种PIMs、≥1种药物相互作用或ACB≥3。