Medication undertreatment in assisted living settings
Medication undertreatment in assisted living settings
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DOI：
10.1001/archinte.164.18.2031
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发表时间：
2004-10-11
影响因子：
--
通讯作者：
Hebel, JR
中科院分区：
文献类型：
--
作者：
Sloane, PD;Gruber-Baldini, AL;Hebel, JR
背景：住院护理/辅助生活（RC/AL）是一个快速发展的长期护理环境，其中药物使用尚未得到仔细检查。我们试图确定某些药物的非处方患病率和预测因素，这些药物在降低发病率方面的价值已在临床试验中得到证实。方法：作为对佛罗里达州、马里兰州、新泽西州和北卡罗来纳州 193 个 RC/AL 机构分层随机样本调查的一部分，收集了 2014 名 65 岁及以上居民的数据。根据病历审查和现场患者评估记录患者特征和诊断；记录过去 7 天中至少 4 天服用的所有药物。有关设施特征的数据是通过采访设施管理员获得的。采用双变量和多变量 Logistic 回归来确定非处方药物与设施特征、医生就诊以及患者年龄、性别、种族、合并症、功能依赖性和认知之间的关联。 结果：在 328 名充血性心力衰竭受试者中，204 名 (62.2%) 没有接受血管紧张素转换酶抑制剂治疗；在 172 名既往患有心肌梗塞的受试者中，60.5% 未接受阿司匹林治疗，76.2% 未接受 β 受体阻滞剂治疗；在 435 名有中风病史的患者中，37.5% 没有接受抗凝剂或抗血小板剂；在 315 名骨质疏松症患者中，61.0% 没有接受钙补充剂，51.1% 没有接受任何治疗。住院医师年龄、种族、性别、合并症、认知状态和日常生活活动依赖性很少与非处方相关；相比之下，设施因素（尤其是设施类型和医生就诊频率）与非处方的相关性更高一些。结论：治疗不足在 RC/AL 设施中似乎很普遍。由于保持独立通常是这些环境中护理的主要目标，因此可能需要更多地关注已被证明可以降低长期发病率的治疗方法的使用。
Background:: Residential care/assisted living (RC/AL) is a rapidly growing, long-term care setting, where medication use has not been carefully examined. We sought to determine the prevalence and predictors of nonprescribing of selected medications whose value in decreasing morbidity has been established in clinical trials.Methods: As part of a survey of a stratified random sample of 193 RC/AL facilities in Florida, Maryland, New Jersey, and North Carolina, data were gathered on 2014 residents 65 years and older. Patient characteristics and diagnoses were recorded based on medical record reviews and in-person patient assessments; all medications administered at least 4 of the previous 7 days were recorded. Data on facility characteristics were obtained by interviewing facility administrators. Bivariate and multivariate logistic regression was performed to identify associations between medication nonprescribing and facility characteristics, physician visitation, and patient age, sex, race, comorbidity, functional dependency, and cognition.Results: Of 328 subjects with congestive heart failure, 204 (62.2%) were not receiving an angiotensin-converting enzyme inhibitor; of 172 subjects with prior myocardial infarction, 60.5% were not receiving aspirin and 76.2% were not receiving beta-blockers; of 435 patients with history of stroke, 37.5% were not receiving an anticoagulant or antiplatelet agent; and of 315 patients with osteoporosis, 61.0% were not receiving calcium supplementation and 51.1% were not receiving any treatment for the condition. Resident age, race, sex, comorbidity, cognitive status, and dependency in activities of daily living were rarely associated with nonprescribing; in contrast, facility factors-particularly facility type and the frequency of physician visits-were somewhat more frequently associated with nonprescribing.Conclusions: Undertreatment appears to be prevalent in RC/AL facilities. Since preserving independence is often a primary goal of care in these settings, more attention may need to be paid to the use of treatments that have been shown to reduce long-term morbidity.