INAPPROPRIATE MEDICATION PRESCRIBING IN SKILLED-NURSING FACILITIES
INAPPROPRIATE MEDICATION PRESCRIBING IN SKILLED-NURSING FACILITIES
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DOI：
10.7326/0003-4819-117-8-684
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发表时间：
1992-10-15
影响因子：
39.2
通讯作者：
BECK, JC
中科院分区：
文献类型：
--
作者：
BEERS, MH;OUSLANDER, JG;BECK, JC
目的：了解养老院居民用药处方的适宜性。设计：前瞻性队列研究。背景：在大洛杉矶地区有12家养老院。参与者：共1106名养老院居民。主要结果测量：药物处方的适当性使用明确的标准进行评估，该标准是由来自美国和加拿大的13位专家通过共识制定的。这些专家确定了19种一般应避免使用的药物，以及11种一般不应超过的特定药物的剂量、频率或使用时间。结果：根据共识标准，40%的住院医师至少收到过一次不适当用药单，10%的住院医师同时收到两次或两次以上不适当用药单；7%的处方不恰当。医生给女性住院医生开了更多不合适的药物。回归分析，校正了设施内的聚类效应，表明在较大的养老院订购了更多的不适当的药物处方。不适当的处方与医疗补助（Medi-Cal）居民的比例或在家中执业的医生数量无关。结论：养老院用药不当现象普遍存在。女性居民和大型养老院的居民接受不适当处方的风险最大。
Objective: To quantity the appropriateness of medication prescriptions in nursing home residents.Design: Prospective, cohort study.Setting: Twelve nursing homes in the greater Los Angeles area.Participants: A total of 1106 nursing home residents.Main Outcome Measures: The appropriateness of medication prescriptions was evaluated using explicit criteria developed through consensus by 13 experts from the United States and Canada. These experts identified 19 drugs that should generally be avoided and 11 doses, frequencies, or durations of use of specific drugs that generally should not be exceeded.Results: Based on the consensus criteria, 40% of residents received at least one inappropriate medication order, and 10% received two or more inappropriate medication orders concurrently; 7% of all prescriptions were inappropriate. Physicians prescribed a greater number of inappropriate medications for female residents. Regression analysis, corrected for clustering effects within facilities, showed that a greater number of inappropriate medication prescriptions were ordered in larger nursing homes. Inappropriate prescriptions were not related to the proportion of Medicaid (Medi-Cal) residents or the number of physicians practicing in the homes.Conclusions: Inappropriate medication prescribing in nursing homes is common. Female residents and residents of large nursing homes are at the greatest risk for receiving an inappropriate prescription.