Inappropriate Medication in a National Sample of US Elderly Patients Receiving Home Health Care
Inappropriate Medication in a National Sample of US Elderly Patients Receiving Home Health Care
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DOI：
10.1007/s11606-011-1905-4
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发表时间：
2012-03-01
影响因子：
5.7
通讯作者：
Bruce, Martha L.
中科院分区：
文献类型：
--
作者：
Bao, Yuhua;Shao, Huibo;Bruce, Martha L.
背景：接受家庭保健的老年患者发病率高，功能受损，特别容易受到不安全或无效药物的不良影响。然而，家庭健康机构的药物审查和协调服务提供了一种额外的药物安全机制，可以抵消这种风险。目的：估计美国当前老年家庭健康患者中潜在不适当药物(PIM)的流行率。设计：使用来自2007年全国家庭和临终关怀调查的数据进行横断面分析。研究对象：3124名65岁或以上的家庭健康患者，至少服用一种药物。MAIN测量：PIM使用的流行率和分类，以及PIM使用与患者和家庭健康机构特征之间的关联。KEY结果：2007年，38%(95%CI：36-41)的老年家庭健康患者至少服用过一次PIM。多药联用与PIM使用风险增加相关；从疗养院或其他亚急性机构进入家庭卫生保健(与社区入院相比)以及医疗保险或医疗补助以外的其他支付来源与PIM使用风险降低相关。结论：尽管存在改善安全性的潜在机制，但老年家庭健康患者使用PIM的患病率仍然很高。为了降低老年家庭健康患者使用PIM的流行率，可能需要制定政策来改善家庭健康机构内部的审查和对账过程，并改善医生与家庭健康临床医生的合作。
BACKGROUND: With substantial morbidity and functional impairment, older patients receiving home health care are especially susceptible to the adverse effects of unsafe or ineffective medications. Home health agencies' medication review and reconciliation services, however, provide an added mechanism of medication safety that could offset this risk.OBJECTIVE: To estimate the prevalence of potentially inappropriate medications (PIMs) among current elderly home health patients in the US.DESIGN: Cross-sectional analysis using data from the 2007 National Home and Hospice Care Survey.SUBJECTS: 3,124 home health patients 65 years of age or older on at least one medication.MAIN MEASURES: Prevalence and classification of PIM use and the association between PIM use and patient and home health agency characteristics.KEY RESULTS: In 2007, 38% (95% CI: 36-41) of elderly home health patients were taking at least one PIM. Polypharmacy was associated with an increased risk of PIM use; admission to home health care from a nursing home or other sub-acute facility (compared to admission from the community) and a payment source other than Medicare or Medicaid were associated with a decreased risk of PIM use.CONCLUSIONS: The prevalence of PIM use in older home health patients is high despite potential mechanisms for improved safety. Policies to improve the review and reconciliation processes within home health agencies and to improve physician-home health clinician collaboration are likely needed to lower the prevalence of PIM use in older home health patients.