老年特发性肺纤维化（IPF）退伍军人中的多重用药及潜在不适当用药（PIM）情况——一项回顾性队列研究
Polypharmacy and potentially inappropriate medication (PIM) use among older veterans with idiopathic pulmonary fibrosis (IPF) - a retrospective cohort study.
作者信息
Guidot Daniel M, Pepin Marc, Hastings S Nicole, Tighe Robert, Schmader Kenneth
机构信息
Geriatrics Research Education and Care Center, Durham VA Medical Center, 2035 Joshua Ln Durham, Durham, NC, 27703, USA.
Division of Pulmonary and Critical Care, Duke University Medical Center, Durham, NC, USA.
出版信息
BMC Pulm Med. 2025 Apr 21;25(1):186. doi: 10.1186/s12890-025-03611-2.
BACKGROUND
Idiopathic pulmonary fibrosis (IPF) is a deadly respiratory disease of older patients. IPF therapies (antifibrotics) are efficacious in slowing disease progression, but they are critically underutilized. Potential barriers to antifibrotic use are polypharmacy and potentially inappropriate medications (PIM). We examined the frequency of these factors for older patients with IPF.
METHODS
We retrospectively analyzed records of Veterans ≥ 65 years old in the Durham Veterans Affairs Health Care System who received a diagnosis of IPF and received care between 11 April 2023 and 9 September 2024. We analyzed medication profiles from the Corporate Data Warehouse including total medication counts, polypharmacy (≥ 5 medications), severe polypharmacy (> 15 medications), and prescription of a PIM in the anticholinergic, antidepressant, sedative, and antipsychotic classes using published geriatric guidelines (2023 Beers criteria, Screening Tool of Older People's Potentially Inappropriate Prescriptions [STOPP] version 3). Identified PIMs underwent protocolized review to categorize them further as likely appropriate or inappropriate.
RESULTS
We identified 367 Veterans ≥ 65 years old with a diagnosis of IPF diagnostic during our study period. Total medication count was high for older Veterans (mean 14.2, SD 7.0). Veterans commonly had polypharmacy (350/367, 95.4%), severe polypharmacy (161/367, 43.9%), and ≥ 1 PIM (97/367, 26.4%). After protocolized review, 5.7% (21/367) of older Veterans with IPF had a likely inappropriate medication without documentation of a failed preferred alternative.
CONCLUSION
For older Veterans with IPF, polypharmacy and PIM use were common and represent likely barriers to effective IPF pharmacotherapy initiation. Interventions that target these factors like deprescribing could improve antifibrotic use.
CLINICAL TRIAL NUMBER
Not applicable.
背景
特发性肺纤维化（IPF）是一种发生于老年患者的致命性呼吸系统疾病。IPF治疗药物（抗纤维化药物）在减缓疾病进展方面有效，但未得到充分利用。抗纤维化药物使用的潜在障碍包括多重用药和潜在不适当用药（PIM）。我们研究了老年IPF患者中这些因素的出现频率。
方法
我们回顾性分析了达勒姆退伍军人事务医疗保健系统中年龄≥65岁、被诊断为IPF且在2023年4月11日至2024年9月9日期间接受治疗的退伍军人的记录。我们从企业数据仓库分析了用药情况，包括用药总数、多重用药（≥5种药物）、严重多重用药（>15种药物），以及根据已发表的老年指南（2023年Beers标准、老年人潜在不适当处方筛查工具[STOPP]第3版）开具的抗胆碱能、抗抑郁、镇静和抗精神病类PIM。对确定的PIM进行规范化审查，以进一步将其分类为可能适当或不适当。
结果
在我们的研究期间，我们确定了367名年龄≥65岁且被诊断为IPF的退伍军人。老年退伍军人的用药总数较高（平均14.2，标准差7.0）。退伍军人普遍存在多重用药（350/367，95.4%）、严重多重用药（161/367，43.9%）以及≥1种PIM（97/367，26.4%）。经过规范化审查，5.7%（21/367）的老年IPF退伍军人有一种可能不适当的药物，且没有记录显示首选替代药物无效。
结论
对于老年IPF退伍军人，多重用药和PIM的使用很常见，可能是启动有效的IPF药物治疗的障碍。针对这些因素的干预措施，如减药，可能会改善抗纤维化药物的使用。
临床试验编号
不适用。
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