Focus and features of prescribing indications spanning multiple chronic conditions in older adults: A narrative review.
Focus and features of prescribing indications spanning multiple chronic conditions in older adults: A narrative review.
复制标题
DOI：
10.1177/26335565211012876
复制
发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Wei, Melissa Y
中科院分区：
文献类型：
--
作者：
Aubert, Carole E;Kerr, Eve A;Klamerus, Mandi L;Hofer, Timothy P;Wei, Melissa Y
不适当的处方在老年人中很常见，并与不良结局相关。处方适应症旨在优化处方，但对老年人最常见的慢性病处方适应症的重点和特点知之甚少。了解病情、药物和解决的问题（例如，患者观点、药物-疾病相互作用、药物不良事件）可能有助于识别缺失的适应症，并制定标准化措施以提高处方质量。我们在奥维德/MEDLINE和EMBASE中检索了2015年至2020年间发表的报告老年人处方适应症的文章。处方适应症包括1）处方“标准”或指导处方行动的声明，以及2）处方“措施”或在人群中观察到的处方行动。我们根据病情、药物和解决的问题以及提供的证据水平对其重点进行了分类。在16组处方适应症中，我们确定了748项标准和47项措施。最常见的药物为降压药、镇痛药/抗风湿药和抗血小板药/抗凝剂。最常见的问题是药物-疾病相互作用、药物不良事件、给药、更好的治疗选择和（共同）处方遗漏（20.8-36.1%）。仅在9.9-16.5%的适应症中发现了年龄/功能、药物间相互作用、监测和疗效/安全性比。适应症很少关注患者的角度或多个提供者的问题。大多数老年患者慢性疾病的处方适应症是标准而不是措施。考虑患者观点和多个提供者的适应症有限。本次审查中发现的差距可能有助于改善老年人处方措施的制定，并最终提高护理质量。
Inappropriate prescribing is frequent in older adults and associated with adverse outcomes. Prescribing indications aim to optimize prescribing, but little is known about the focus and features of prescribing indications for the most common chronic conditions in older adults. Understanding the conditions, medications, and issues addressed (e.g., patient perspective, drug-disease interaction, adverse drug event) in current prescribing indications may help to identify missing indications and develop standardized measures to improve prescribing quality. We searched Ovid/MEDLINE and EMBASE for articles published between 2015 and 2020 reporting prescribing indications for older adults. Prescribing indication included 1) prescribing “criteria,” or statements that guide prescribing action, and 2) prescribing “measures,” or prescribing actions observed in a population. We categorized their focus by conditions, medications and issues addressed, as well as level of evidence provided. Among 16 sets of prescribing indications, we identified 748 criteria and 47 measures. The most common addressed medications were antihypertensives, analgesics/antirheumatics, and antiplatelets/anticoagulants. The most frequently addressed issues were drug-disease interaction, adverse drug event, administration, better therapeutic alternative, and (co-)prescription omission (20.8–36.1%). Age/functioning, drug-drug interaction, monitoring, and efficacy/safety ratio were found in only 9.9–16.5% of indications. Indications rarely focused on the patient perspective or issues with multiple providers. Most prescribing indications for chronic conditions in older patients are criteria rather than measures. Indications accounting for patient perspective and multiple providers are limited. The gaps identified in this review may help improve the development of prescribing measures for older adults and ultimately improve quality of care.