Inappropriate medication prescribing in residential care/assisted living facilities.
Inappropriate medication prescribing in residential care/assisted living facilities.
复制标题
住院护理/辅助生活设施中开具的药物不当。
DOI：
10.1046/j.1532-5415.2002.50253.x
复制
发表时间：
2002
影响因子：
6.3
通讯作者：
Walsh,JoanF
中科院分区：
文献类型：
--
作者：
Sloane,PhilipD;Zimmerman,Sheryl;Brown,LoriC;Ives,TimothyJ;Walsh,JoanF
目的：确定住院护理/辅助生活(RC/AL)设施中老年患者接受不适当处方药物(IPMS)的程度，并描述与接受一个或多个IPMS相关的设施和居民因素。设计：对四个州193个设施的分层、代表性样本进行横断面研究。集合：我们确定了佛罗里达州、新泽西州、北卡罗来纳州和马里兰州具有代表性的地理区域，并从其中抽取了193个RC/AL设施的分层随机样本。样本中包括三种类型的设施：小型住宅(16个床位)、较大的“新型”住宅和较大的“传统”住宅。对比：在每个较大的住宅中，随机抽取65岁及以上的居民征求同意；在较小的住宅中，询问所有居民。总入学率为92%；有2078名居民参加。测量：采用问卷调查和现场观察的方式收集设施管理、人员配置和居民特征的数据。所有处方药和非处方药在数据收集前7天中至少有4天是从用药记录中提取的，并进行编码以供分析。IPM的指定是基于对Beers等人开发的清单的修改。结果：大多数RC/AL患者正在服用5种或5种以上的药物，其中16.0%的患者接受了IPMS。最常见的IPMS是奥昔布宁、丙氧酚、苯海拉明、噻氯匹定、多塞平和双嘧达莫。在使用广义估计方程的多变量分析中，IPM的使用与接受药物的数量、较小的设施床位大小、适度的执业护士更替、无痴呆症、较低的月费以及没有每周看医生有关。结论：IPMS在长期护理中仍然是一个问题，但这些RC/AL环境中的比率与其他虚弱老年人口的报告相比是有利的，这表明具有严重不良反应的药物的使用可能正在减少。定期到内科机构就诊可能会改善处方，注意高危群体，如服用多种药物的个人。
OBJECTIVES:To identify the extent to which inappropriately prescribed medications (IPMs) are administered to older patients in residential care/assisted living (RC/AL) facilities and to describe facility and resident factors associated with receipt of one or more IPMs.DESIGN:Cross‐sectional study of a stratified, representative sample of 193 facilities in four states.SETTING:We identified representative geographic regions within Florida, New Jersey, North Carolina, and Maryland and drew from within them a stratified random sample of 193 RC/AL facilities. Three subtypes of facilities were included in the sample: small homes (<16 beds), larger “new‐model” homes, and larger “traditional” homes.PARTICIPANTS:Within each larger home, a random sample of residents aged 65 and older was approached for consent; in smaller homes all residents were approached. The overall enrollment rate was 92%; 2,078 residents were enrolled.MEASUREMENTS:Questionnaires and on‐site observations were used to gather data on facility administration and staffing and resident characteristics. All prescription and nonprescription medications taken at least 4 of the 7 days before data collection were taken from medication administration records and coded for analysis. IPM designation was based on modification of a list developed by Beers et al. and currently used by nursing home surveyors.RESULTS:The majority of RC/AL patients were taking five or more medications; 16.0% of these patients were receiving IPMs. The most common IPMs were oxybutynin, propoxyphene, diphenhydramine, ticlopidine, doxepin, and dipyridamole. In multivariate analyses, using generalized estimating equations, IPM use was associated with the number of medications received, smaller facility bed size, moderate licensed practical nurse turnover, absence of dementia, low monthly fees, and absence of weekly physician visits.CONCLUSIONS:IPMs remain a problem in long‐term care, but rates in these RC/AL settings compare favorably with those reported for other frail older populations, suggesting that use of medications with severe adverse effects may be waning. Regular physician facility visits may improve prescribing, as will attention to high‐risk groups such as individuals on multiple medications.
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影响因子：
7
作者：
Elmstahl, S;Stenberg, I;Ingvad, B
通讯作者：
Ingvad, B
DOI：
--
发表时间：
2006
期刊：
影响因子：
--
作者：
R. Elliott
通讯作者：
R. Elliott
澳大利亚退伍军人和战争寡妇/鳏夫的处方可能不恰当
DOI：
--
发表时间：
2007
期刊：
Internal medicine journal (Print)
影响因子：
--
作者：
E. Roughead;B. Anderson;A. Gilbert
通讯作者：
A. Gilbert
影响因子：
11.4
作者：
J. O'Halloran;H. Britt;L. Valenti
通讯作者：
L. Valenti
DOI：
10.1046/j.1532-5415.2001.4930277.x
发表时间：
2001-03-01
影响因子：
6.3
作者：
Giron, MST;Wang, HX;Fastbom, J
通讯作者：
Fastbom, J