Use of a frailty index to identify potentially inappropriate prescribing and adverse drug reaction risks in older patients
Use of a frailty index to identify potentially inappropriate prescribing and adverse drug reaction risks in older patients
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DOI：
10.1093/ageing/afv166
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发表时间：
2016-01-01
期刊：
影响因子：
6.7
通讯作者：
Byrne, Stephen
中科院分区：
文献类型：
--
作者：
Cullinan, Shane;O'Mahony, Denis;Byrne, Stephen
背景：潜在的不适当处方(PIP)是当今医疗保健中的一个重大问题。我们假设，如果医生在病人的处方上得到PIP和药物不良反应(ADR)风险的单一指标，可能会刺激他们审查药物。我们认为，虚弱指数(FI)评分可能是这样一个合适的指标。目的：确定患者的虚弱状态、他们的药物适当性和他们发生ADR的倾向之间是否存在正相关。将这与仅仅使用患者服用的药物数量作为PIP/ADR风险的指标进行比较。设置和方法：构建脆弱指数并将其应用于患者数据库。通过皮尔逊相关检验和CHI(2)检验，确定患者的FI评分、处方上的PIP例数与发生ADR的可能性之间的关联。结果：PIP的FI评分例数之间存在显著的相关性(R=0.92)。患者至少经历过一次PIP的FI评分平均为0.16。超过这一阈值的患者发生肺部感染的可能性是前者的两倍(OR=2.6P<；0.0001)，发生不良反应的可能性是后者的两倍(OR=2.1P<；0.0001)。服用6种以上药物的患者发生PIP的可能性是后者的3倍。结论：FI评分是一个潜在的相关临床指标，医生可以用来严格评估患者的处方中是否存在PIP，并最终预防ADRS，特别是当与患者服用的药物数量一起使用时。
Background: potentially inappropriate prescribing (PIP) is a significant problem in health care today. We hypothesise that if doctors were given a single indicator of PIP and adverse drug reaction (ADR) risk on a patient's prescription, it might stimulate them to review the medicines. We suggest that a frailty index (FI) score may be such a suitable indicator.Objectives: to determine whether a positive relationship exists between a patient's frailty status, the appropriateness of their medications and their propensity to develop ADRs. Compare this to just using the number of medications a patient takes as an indicator of PIP/ADR risk.Setting and method: a frailty index was constructed and applied to a patient database. The associations between a patient's FI score, the number of instances of PIP on their prescription and their likelihood of developing an ADR were determined using Pearson correlation tests and chi(2) tests.Results: significant correlation between FI score instances of PIP was shown (R = 0.92). The mean FI score above which patients experienced at least one instance of PIP was 0.16. Patients above this threshold were twice as likely to experience PIP (OR = 2.6, P < 0.0001) and twice as likely to develop an ADR (OR = 2.1, P < 0.0001). Patients taking more than six medications were 3 times more likely to experience PIP.Conclusion: an FI score is a potentially relevant clinical indicator for doctors to critically assess a patient's prescription for the presence of PIP and ultimately prevent ADRs, especially when used in tandem with the number of medications a patient takes.