Inappropriate Medication Use as a Risk Factor for Self-Reported Adverse Drug Effects in Older Adults
Inappropriate Medication Use as a Risk Factor for Self-Reported Adverse Drug Effects in Older Adults
复制标题
DOI：
10.1111/j.1532-5415.2009.02269.x
复制
发表时间：
2009-06-01
影响因子：
6.3
通讯作者：
Wallace, Robert B.
中科院分区：
文献类型：
--
作者：
Chrischilles, Elizabeth A.;VanGilder, Rachel;Wallace, Robert B.
确定不适当的药物使用与自我报告的药物不良反应（ADE）之间的关系。前瞻性队列研究，采用三次年度邮寄调查。爱荷华州医疗保险受益人的基于人群的样本。队列成员（n=626）具有确定的行动不便和完整的药房配药记录，连续的医疗保险资格，和调查数据。在ADE调查前一年，对分配的独特药物成分和不适当使用的数量进行了评估。不适当的药物使用是根据已发表的标准定义的：老年人禁忌药物，药物-疾病相互作用（根据相关的医疗保险索赔构建），药物-药物相互作用和治疗重复。ADE是根据以下问题定义的：“在过去的12个月里，您是否经历过药物的不良反应或副作用？在ADE调查的受访者中，22.0%的人报告在过去一年中经历过ADE，322人（51.4%）接受了至少一种潜在的不适当药物。与ADE自我报告单变量相关的因素是药物数量、活动受限数量、任何不适当的药物使用、每个领域适当性指标以及不同领域的不适当使用数量。不适当用药与无不适当用药相比，发生ADE的调整优势比为2.14（95%置信区间=1.26-3.65）。应鼓励通过减少药物不适当性来减少ADE，作为减少处方药物数量的补充。
To determine the association between inappropriate medication use and self-reported adverse drug effects (ADEs).Prospective cohort study with three annual mailed surveys.Population-based sample of Iowa Medicare beneficiaries.Cohort members (n=626) with established mobility disability and complete pharmacy dispensing records, continuous Medicare eligibility, and survey data.The number of unique drug ingredients dispensed and inappropriate use were assessed for the year before the ADE survey. Inappropriate medication use was defined according to published criteria: contraindicated drugs for elderly people, drug-disease interactions (constructed from linked Medicare claims), drug-drug interactions, and therapeutic duplications. An ADE was defined from the following question: "In the past 12 months, have you experienced an unwanted effect or side effect of a medication?"Of respondents to the ADE survey, 22.0% reported having experienced an ADE in the past year, and 322 (51.4%) received at least one potential inappropriate medication. Factors associated univariately with ADE self-report were number of medications, number of mobility limitations, any inappropriate medication use, and each of the individual domain appropriateness indicators, as well as number of different domains of inappropriate use. The adjusted odds ratio for developing an ADE was 2.14 (95% confidence interval=1.26-3.65) for those with inappropriate use versus no inappropriate use.Efforts to reduce ADEs by reducing medication inappropriateness should be encouraged as a complement to efforts focused on reducing the number of medications prescribed.