Zhao Zinan, Fu Mengyuan, Li Can, Gong Zhiwen, Li Ting, Ling Kexin, Li Huangqianyu, Li Jianchun, Cao Weihang, Hong Dongzhe, Hu Xin, Shi Luwen, Guan Xiaodong, Jin Pengfei
Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing 100730, China.
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
Chin Med J (Engl). 2025 Jan 23. doi: 10.1097/CM9.0000000000003426.
The use of potentially inappropriate medications (PIMs) is a major concern for medication safety as it may entail more harm than potential benefits for older adults. This study aimed to explore the prescribing rate, healthcare utilization, and expenditure of older adults using PIMs in China.
A cross-sectional analysis was conducted using a national representative database of all medical insurance beneficiaries across China, extracting ambulatory visit records of adults aged 65 years and above between 2015 and 2017. Descriptive analysis was conducted to measure the rate of patients exposed to PIM, prescribing rate of each PIM, average annual outpatient visits per patient, average total medication costs for each visit, average annual cost of PIMs for each patient, and average annual medication costs for each patient. Generalized linear model with logit link function and binomial distribution was used to examine the adjusted associations between PIMs and independent variables.
In total, 845,278 (33.2%) participants were identified to be exposed to at least one PIM. Patients aged 75-84 years (38.1%) and ≥85 years (37.9%) were more likely to be prescribed with PIMs. Beneficiaries of the Urban Employee Basic Medical Insurance (UEBMI) and living in eastern and southern regions were more frequently prescribed with PIMs. Compared with patients without PIM exposure (7.5 visits, drug cost of RMB 1545.0 Yuan), patients with PIM exposure showed higher adjusted average annual number of outpatient visits (10.7 visits, β = 3.228, 95% confidence interval [CI] = 3.196-3.261) and higher annual drug costs (RMB 2461.8 Yuan, Coef. = 916.864, 95% CI = RMB 906.292-927.436 Yuan).
The results showed that the use of PIM among older adults was common in China. This study suggests that it represents a clear target, pending multidimensional efforts, to promote rational prescribing for older adults.
使用潜在不适当药物（PIMs）是药物安全的一个主要关注点，因为这对老年人可能带来的危害大于潜在益处。本研究旨在探讨中国使用PIMs的老年人的处方率、医疗保健利用情况和支出。
利用全国所有医疗保险受益人的具有代表性的数据库进行横断面分析，提取2015年至2017年65岁及以上成年人的门诊就诊记录。进行描述性分析以衡量接触PIMs的患者比例、每种PIMs的处方率、每位患者的年均门诊就诊次数、每次就诊的平均总药费、每位患者的PIMs年均费用以及每位患者的年均药费。使用具有logit连接函数和二项分布的广义线性模型来检验PIMs与自变量之间的校正关联。
总共确定845,278名（33.2%）参与者接触过至少一种PIMs。75 - 84岁（38.1%）和≥85岁（37.9%）的患者更有可能被开具PIMs处方。城镇职工基本医疗保险（UEBMI）受益人以及居住在东部和南部地区的人更频繁地被开具PIMs处方。与未接触PIMs的患者（7.5次就诊，药费1545.0元人民币）相比，接触PIMs的患者校正后的年均门诊就诊次数更高（10.7次就诊，β = 3.228，95%置信区间[CI] = 3.196 - 3.261），年均药费更高（2461.8元人民币，系数 = 916.864，95% CI = 906.292 - 927.436元人民币）。
结果表明，中国老年人中使用PIMs的情况很常见。本研究表明，在进行多方面努力之前，促进老年人合理用药是一个明确的目标。
