Schmader K, Hanlon J T, Weinberger M, Landsman P B, Samsa G P, Lewis I, Uttech K, Cohen H J, Feussner J R
Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, NC.
J Am Geriatr Soc. 1994 Dec;42(12):1241-7. doi: 10.1111/j.1532-5415.1994.tb06504.x.
To assess the quality of medication prescribing in ambulatory elderly patients on multiple medications using the Medication Appropriateness Index (MAI).
Cross-sectional study.
General Medical Clinic of the Durham VA Medical Center.
208 elderly outpatients on five or more regularly scheduled medications.
Medication prescribing appropriateness was measured with the MAI, a reliable method that employs 10 implicit criteria. A weighted MAI score (range 0-18 per drug) served as a summary measure of appropriateness.
There were 1644 medications evaluated; 26% received no inappropriate ratings, 37% had one, 19% had two, and 18% had three or more. Of 16,440 ratings, 2295 (14%) were evaluated as inappropriate. The percentage of inappropriate ratings varied across prescribing dimensions: drug-drug interactions, 0%; drug-disease interactions, 1.4%; medication effectiveness, 4.7%; therapeutic duplication, 5.7%; indication, 11.5%; duration of treatment, 16.5%; dosage, 17.3%; practical directions, 20.3%; cost, 29.7%; and correct directions, 32.4%. The mean MAI score for all medications was 2.2 +/- 2.1 (range 0-10) and varied by therapeutic class. MAI scores were significantly lower for medications with a high potential for adverse effects compared with those with a low potential (MAI score of 1.8 vs 2.9, P < 0.001). Regression analysis revealed that no patient characteristics were associated with a higher likelihood of inappropriate prescribing.
Medication prescribing for elderly outpatients taking multiple medications was substantially appropriate. Prescribing dimensions with the most room for improvement were more exact directions, less expensive drugs, and practical directions. Drugs at high risk for adverse effects were prescribed more appropriately than those at low risk.
使用用药合理性指数（MAI）评估服用多种药物的老年门诊患者的用药处方质量。
横断面研究。
达勒姆退伍军人医疗中心综合内科诊所。
208名服用五种或更多定期处方药的老年门诊患者。
用药处方合理性采用MAI进行测量，MAI是一种采用10条隐含标准的可靠方法。加权MAI评分（每种药物范围为0 - 18分）作为合理性的综合衡量指标。
共评估了1644种药物；26%未得到不当评分，37%有一项不当，19%有两项，18%有三项或更多。在16440项评分中，2295项（14%）被评估为不当。不当评分的百分比在不同处方维度有所不同：药物相互作用，0%；药物 - 疾病相互作用，1.4%；药物疗效，4.7%；治疗重复，5.7%；适应证，11.5%；治疗持续时间，16.5%；剂量，17.3%；实际用药说明，20.3%；费用，29.7%；以及正确用药说明，32.4%。所有药物的平均MAI评分为2.2±2.1（范围0 - 10），且因治疗类别而异。与不良反应可能性低的药物相比，不良反应可能性高的药物的MAI评分显著更低（MAI评分为1.8对2.9，P < 0.001）。回归分析显示，没有患者特征与不当处方的较高可能性相关。
为服用多种药物的老年门诊患者开具的处方总体上较为合理。最具改进空间的处方维度是更精确的用药说明、费用更低的药物以及实际用药说明。不良反应高风险药物的处方比低风险药物更合理。
