Tamblyn R M, McLeod P J, Abrahamowicz M, Laprise R
Department of Medicine, McGill University, Montreal, Que.
CMAJ. 1996 Apr 15;154(8):1177-84.
To determine (a) whether the risk of a potentially inappropriate drug combination (PIDC) increases with the number of physicians involved in the medical management of an elderly patient and (b) whether the risk of a PIDC is reduced if a patient has a single primary care physician or a single dispensing pharmacy, or both.
Cross-sectional retrospective provincial database study.
A regionally stratified random sample of 51,587 elderly medicare registrants in Quebec who (a) visited at least one physician in 1990, (b) were not living in a health care institution for the entire year and (c) had been dispensed at least one prescription for a cardiovascular drug, a psychotropic drug or a nonsteroidal anti-inflammatory drug (NSAID).
Information on all physician visits and drugs dispensed during 1990. Physician claims were used to identify the number of physicians involved in a patient's management and whether the patient had one primary care physician. Prescription claims were used to identify the number of PIDCs, prescribing physicians and dispensing pharmacies.
The prevalence of PIDCs ranged from 4.0% (among those in the NSAID group) to 20.3% (among those in the psychotropic drug group). Of the PIDCs identified, 17.6% to 25.8% resulted from contemporaneous prescribing by different physicians. The number of prescribing physicians was the most important risk factor for a PIDC in all drug groups (odds ratio [OR] 1.44 to 1.71). The presence of a single primary care physician lowered the risk for cardiovascular and psychotropic PIDCs (OR 0.70 and 0.79 respectively) but not for NSAID PIDCs (OR 0.94). The use of a single dispensing pharmacy lowered the risk of a PIDC in all drug groups (OR 0.68 to 0.79).
The greater the number of physicians prescribing medications for an elderly patient, the greater is the risk that the patient will receive a PIDC. A single primary care physician and a single dispensing pharmacy may be "protective" factors in preventing PIDCs.
确定（a）老年患者医疗管理中涉及的医生数量增加是否会使潜在不适当药物组合（PIDC）的风险增加，以及（b）如果患者有单一的初级保健医生或单一的配药药房，或两者兼而有之，PIDC的风险是否会降低。
横断面回顾性省级数据库研究。
对魁北克省51587名老年医疗保险登记者进行区域分层随机抽样，这些登记者（a）在1990年至少拜访过一名医生，（b）全年未居住在医疗机构，（c）至少有一张心血管药物、精神药物或非甾体抗炎药（NSAID）的处方。
1990年期间所有医生诊疗和配药的信息。医生报销记录用于确定参与患者管理的医生数量以及患者是否有一名初级保健医生。处方报销记录用于确定PIDC的数量、开处方的医生和配药药房。
PIDC的患病率从4.0%（非甾体抗炎药组）到20.3%（精神药物组）不等。在确定的PIDC中，17.6%至25.8%是由不同医生同时开处方导致的。在所有药物组中，开处方医生的数量是PIDC最重要的风险因素（优势比[OR]为1.44至1.71）。有单一的初级保健医生可降低心血管和精神类PIDC的风险（分别为OR 0.70和0.79），但不能降低非甾体抗炎药PIDC的风险（OR 0.94）。使用单一的配药药房可降低所有药物组中PIDC的风险（OR 0.68至0.79）。
为老年患者开处方的医生数量越多，患者接受PIDC的风险就越大。单一的初级保健医生和单一的配药药房可能是预防PIDC的“保护”因素。
