Multidrug use positively correlates with high-risk prescriptions in the Japanese elderly: a longitudinal study
Multidrug use positively correlates with high-risk prescriptions in the Japanese elderly: a longitudinal study
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DOI：
10.1186/s40780-019-0150-6
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发表时间：
2019-09-02
影响因子：
1
通讯作者：
Ishii, Itsuko
中科院分区：
文献类型：
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作者：
Arai, Sayaka;Ishikawa, Takahiro;Ishii, Itsuko
背景缺乏证据表明多种药物的使用会引发不良事件。因此，这项研究的主要目的是澄清日本老年患者使用的药物总数与高风险处方数量之间的关系。方法利用医院电子病历(EMR)对65岁以上门诊患者的处方进行评价。我们将潜在不适当药物的处方(PIM)和具有相同作用机制的药物的重叠处方(DSA)定义为高风险处方。分析用药总量与高风险处方之间的关系。此外，我们进行了二次研究，以确定住院率和伴随的药物内容是否根据高危处方的不同而不同。结果分析了13,630例门诊患者的资料。用药总量与PIMs呈显著正相关。单个PIMs的处方频率随着处方药总量的增加而上升。在使用5种或更多药物的患者中，重叠DSA的优势比(OR)显著更高。此外，在有重叠的抗胆碱能药物处方的患者中，泻药的处方明显更多。几乎所有PIM的使用都不是住院的独立危险因素；相反，PIM的数量是住院的独立危险因素[OR 1.18(95%CI，1.12-1.26)]。结论在接受多药治疗的患者中，PIM的数量和重叠的DSA较多。为了避免不良事件和住院，检查处方并考虑PIM和重叠的DSA的数量可能是有用的。
Background There is a lack of evidence that multidrug use triggers adverse events. Therefore, the main purpose of this study was to clarify the relationship between the total number of drugs and number of high-risk prescriptions administered to Japanese elderly patients. Methods Using hospital electronic medical records (EMR), we evaluated the prescriptions of outpatients aged 65 years or older. We defined prescriptions of potentially inappropriate medications (PIMs) and overlapping prescription of drugs with the same mechanism of action (DSAs) as high-risk prescriptions. We analyzed the relationship among total number of drugs and high-risk prescriptions. In addition, we performed a secondary research to determine whether the hospitalization rate and concomitant medication contents differ depending on the high-risk prescriptions. Results Data for 13,630 outpatients were analyzed. A significant positive correlation between the numbers of total drugs and PIMs was found. The prescription frequency of individual PIMs rose as the total number of prescription drugs increased. The odds ratio (OR) of overlapping DSAs was significantly higher in patients using 5 or more drugs. In addition, there were significantly more prescriptions of laxatives among patients with overlapping prescriptions of anticholinergic drugs. The use of almost all PIMs was not an independent risk factor for hospitalization; instead, the number of PIMs was an independent risk factor for hospitalization [OR 1.18 (95% CI, 1.12-1.26)]. Conclusions The number of PIMs and overlapping DSAs were high in patients receiving multidrug treatment. To avoid adverse events and hospitalization, it might be useful to review prescriptions and consider the number of PIMs and overlapping DSAs.