Factors associated with potentially inappropriate medications use by the elderly according to Beers criteria 2003 and 2012
Factors associated with potentially inappropriate medications use by the elderly according to Beers criteria 2003 and 2012
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DOI：
10.1007/s11096-013-9880-y
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发表时间：
2014-04-01
影响因子：
2.4
通讯作者：
Leira Pereira, Leonardo Regis
中科院分区：
文献类型：
--
作者：
Baldoni, Andre de Oliveira;Ayres, Lorena Rocha;Leira Pereira, Leonardo Regis
背景：老年人应避免使用可能不适当的药物（PIMs），因为当有更安全的替代药物可用时，这些药物对这一人群具有显著的高风险。因此，应该考虑识别与pim相关的患病率和因素，因为它们提供了有价值的信息，可用于制定确保患者安全的策略。目的根据2003年Beers标准及其2012年更新版本，确定老年人pim使用的患病率、临床和社会经济人口因素。并且，作为次要目标，对两个标准进行了比较。里贝罗普雷图西区基本保健区单位设置药房。方法在巴西公共卫生系统的协助下，对老年人进行横断面观察性研究。通过结构化访谈表格收集患者数据。比尔斯2003年和2012年的标准被用于对pim进行分类。采用比值比分析所使用的pim与自变量之间的关系。采用McNemar的检验和kappa系数的一致性分析了2003年和2012年Beers标准下pim使用的差异。主要结果测量：巴西老年门诊患者pim使用的患病率和相关因素。结果对1000例老年患者进行了访谈。根据2003年和2012年的Beers标准，pim的使用率分别为48.0%和59.2%。与pim使用相关的因素（在两种标准中都很常见）是女性、自我用药、使用非处方药物、与药物不良事件有关的投诉、精神药物、多种药物和某些类别的药物。在2003年和2012年的Beers标准中，pim的使用是不同的（McNemar检验，p < 0.01），尽管观察到这些分类之间存在实质性的一致(kappa系数0.635,95%置信区间（0.588,0.681）。结论：我们的研究显示pim使用的高流行率与各种临床和社会人口因素有关。当通过McNemar测试比较两个标准时，pim的使用被认为是不同的。出现这种差异可能是因为在巴西使用率较高的药物被纳入了Beers 2012年的标准。
Background Potentially inappropriate medications (PIMs) should be avoided by the elderly because they possess a significant high risk for this population when a safer alternative is available. Therefore, the identification of prevalence and factors associated with PIMs should be considered as they provide valuable information that can be used to develop strategies to ensure patients' safety. Objective To identify the prevalence and the clinical and socioeconomic-demographic factors that may be associated with PIMs use in the elderly, according to Beers criteria 2003 and its updated version 2012. And, as a secondary objective, a comparison between both criteria was performed. Setting Pharmacy of the Basic Health District Unit of the western district of Ribeiro Preto. Methods This cross-sectional observational study was conducted with the elderly, assisted by the Brazilian public health system. Data from patients were collected through a structured interview form. Beers criteria 2003 and 2012 were used to classify PIMs. The association between PIMs used and independent variables were analyzed by odds ratios. The differences between PIMs use according to Beers criteria 2003 and 2012 were analyzed by McNemar's test and the agreement by kappa coefficient. Main outcome measure Prevalence and factors associated with PIMs use in Brazilian elderly outpatients. Results One thousand elderly patients were interviewed. High prevalence of PIMs use was observed, 48.0 and 59.2 % according to Beers criteria 2003 and 2012, respectively. The factors associated with PIMs use, common for both criteria, are female gender, self-medication, use of over the counter drugs, complaints related to adverse drug event, psychotropic medication, polypharmacy and some categories of drugs. PIMs use is different between Beers criteria 2003 and 2012 (McNemar's test, p < 0.01), although a substantial agreement between these classifications was observed (kappa coefficient 0.635, 95% confidence intervals (0.588, 0.681). Conclusions Our study showed a high prevalence of PIMs use, which is associated with various clinical and social-demographic factors. When comparing both criteria through McNemar's test, PIMs use was considered different. The differences may have occurred because medications with high prevalence of use in Brazil were included in Beers criteria 2012 .