Determinants of Potentially Inappropriate Medication Use among Community-Dwelling Older Adults
Determinants of Potentially Inappropriate Medication Use among Community-Dwelling Older Adults
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DOI：
10.1111/1475-6773.12562
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发表时间：
2017-08-01
影响因子：
3.4
通讯作者：
Fick, Donna M.
中科院分区：
文献类型：
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作者：
Miller, G. Edward;Sarpong, Eric M.;Fick, Donna M.
目标。检查潜在不适当用药（PIM）的决定因素。数据来源/研究设置。来自2006-2010年医疗支出小组调查的美国全国代表性数据（n = 16,588）非机构老年人（年龄>= 65）吸毒。研究设计。我们运用了2012年Beers标准来确定PIM在这一年中使用情况，并研究了假设为质量支持或与需求复杂性相关的个人层面特征的关联。主要的发现。几乎三分之一（30.9%）的老年人使用PIM。多变量结果表明，健康状况不佳和PIM高风险状况与PIM使用增加有关，而年龄和受教育程度的增加与PIM使用减少有关。与预期相反，缺乏常规护理来源或补充保险与较低的PIM使用率有关。用药强度似乎是质量支持和需求复杂性特征与PIM使用之间的路径。我们的研究结果表明，医生试图避免在最年长的老年人中使用PIM，但对PIM高风险条件的关注不足。针对医生实践的教育项目是潜在的应对措施，这些项目涉及高风险病症和患者对药物使用的认识。
Objective. To examine the determinants of potentially inappropriate medication (PIM) use.Data Sources/Study Setting. U.S. nationally representative data on (n = 16,588) noninstitutionalized older adults (age >= 65) with drug use from the 2006-2010 Medical Expenditure Panel Survey.Study Design. We operationalized the 2012 Beers Criteria to identify PIM use during the year, and we examined associations with individual-level characteristics hypothesized to be quality enabling or related to need complexity.Principal Findings. Almost one-third (30.9 percent) of older adults used a PIM. Multivariate results suggest that poor health status and high-PIM-risk conditions were associated with increased PIM use, while increasing age and educational attainment were associated with lower PIM use. Contrary to expectations, lack of a usual care source of care or supplemental insurance was associated with lower PIM use. Medication intensity appears to be in the pathway between both quality-enabling and need-complexity characteristics and PIM use.Conclusion. Our results suggest that physicians attempt to avoid PIM use in the oldest old but have inadequate focus on the high-PIM-risk conditions. Educational programs targeted to physician practice regarding high-PIM-risk conditions and patient literacy regarding medication use are potential responses.