Polypharmacy in elderly patients at discharge from the acute care hospital.
Polypharmacy in elderly patients at discharge from the acute care hospital.
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DOI：
10.2147/tcrm.2007.3.1.197
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发表时间：
2007-03
影响因子：
2.8
通讯作者：
Incalzi RA
中科院分区：
文献类型：
--
作者：
Corsonello A;Pedone C;Corica F;Incalzi RA
探讨普通内科与老年科出院时多种用药的相关因素。2465例患者入组Gruppo Italiano di Farmacovigilanza nell'Anziano（GIFA）研究。多种用药（出院时处方药超过6种）。根据经验证的程序收集在家中、住院期间和出院时处方的药物数据。Logistic回归分析用于确定出院时多种药物治疗的独立相关因素。对所选药物（洋地黄、利尿剂、抗血栓药、支气管扩张剂）对当前治疗指南的依从性进行评估。入院前处方药物的中位数为3.0，出院时为4.0（p < 0.001）。入院前多种药物治疗（OR 4.32，95%CI 3.13-5.96）、累积合并症（OR 1.81，95%CI 1.40-2.32）和选定的慢性疾病（糖尿病、心力衰竭、慢性阻塞性肺疾病、肾功能不全和抑郁症）与出院时多种药物治疗显著相关。入院前药物不良反应发生率与预后呈负相关（OR 0.22，95%CI 0.09-0.51）。仅抗血栓药物在家中、医院和出院时的合理处方率达到80%。住院增加老年患者出院时的药物处方。需要努力确定决定因素，并评估这种处方做法的质量，最终目的是对比多种药物。
To investigate correlates of polypharmacy at discharge from wards of general medicine and geriatrics. 2465 patients enrolled in the Gruppo Italiano di Farmacovigilanza nell’Anziano (GIFA) study. Polypharmacy, ie having more than 6 drugs prescribed at discharge. Data on drugs prescribed at home, during hospital stay, and at discharge were collected according to a validated procedure. Logistic regression analysis was used to identify independent correlates of polypharmacy at discharge. The adherence to current therapeutic guidelines was assessed for selected drugs (digitalis, diuretics, antithrombotics, bronchodilators) The median number of prescribed drugs was 3.0 before admission and 4.0 at discharge (p < 0.001). Polypharmacy prior to admission (Odds Ratio [OR] 4.32, 95% Confidence Interval [CI] 3.13–5.96), cumulative comorbidity (OR 1.81, 95% CI 1.40–2.32) and selected chronicconditions (diabetes, heart failure, chronic obstructive pulmonary disease, renal insufficiency, and depression) were significant correlates of polypharmacy at discharge. Negative correlate of the outcome was the occurrence of adverse drug reactions prior to admission (OR 0.22, 95% CI 0.09–0.51). The rate of appropriate prescription reached 80% only for antithrombotics either at home or in hospital and at discharge. Hospitalization increases drug prescription at discharge in elderly patients. Efforts are needed to identify the determinants and to assess the quality of this prescription practice, with the final aim of contrasting polypharmacy.