Polypharmacy, Aging and Potential Drug-Drug Interactions in Outpatients in Taiwan A Retrospective Computerized Screening Study
Polypharmacy, Aging and Potential Drug-Drug Interactions in Outpatients in Taiwan A Retrospective Computerized Screening Study
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DOI：
10.2165/11586870-000000000-00000
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发表时间：
2011-01-01
期刊：
影响因子：
2.8
通讯作者：
Bai, Chyi-Huey
中科院分区：
文献类型：
--
作者：
Lin, Chen-Fang;Wang, Chun-Yu;Bai, Chyi-Huey
背景：复合用药在门诊患者中很常见，并已被确定为药物相互作用（DDI）的主要危险因素，而药物相互作用是药物不良反应的重要原因。全球老年患者数量迅速增加。然而，很少有研究量化患者年龄和伴随用药数量对普通门诊患者每人潜在 DDI 概率的影响。 目的： 评估多重用药和老龄化与台湾某医疗中心门诊患者潜在 DDI 的相关程度。 方法： 对 2004 年 1 月至 2004 年 3 月期间到台湾某医疗中心就诊的 81 650 名门诊患者的用药情况进行回顾性筛选使用计算机化药物相互作用程序寻找潜在的 DDI。主要纳入标准是至少有两个药物处方且使用时间为 14 天或以上。我们还分析了 DDI 模式，其中包括潜在 DDI 的严重程度、记录水平和发病情况，并评估了处方药物数量和年龄对每人潜在 DDI 患病率的影响。结果：潜在 DDI 患病率为 25.6%（81 650 人中的 20 902 人）。 20 902 名潜在 DDI 患者的平均 +/- SD 年龄为 57.5 +/- 16.5 岁，其中 47.6% 为男性。存在潜在 DDI 的患者所开处方药物的平均 +/- SD 数量为 5.8 +/- 2.4，其中 67.7% 的患者服用了四种以上药物。大多数 (55.7%) DDI 属于 C2 模式（严重性：中等；记录：可能）。潜在 DDI 的患病率随着年龄的增加 (p < 0.001) 和处方药物的数量 (p < 0.001) 以线性模式增加；此外，这两个因素除了与潜在 DDI 独立相关外，还相互作用，进一步增加了风险。 结论：这项研究表明，2004 年 3 个月内到台湾医疗中心就诊的 81 650 名门诊患者中，约有四分之一患有潜在 DDI。我们观察到，每人潜在 DDI 的独立增加与衰老和处方药数量的增加有关。此外，观察到这两个因素之间存在显着的相互作用：随着处方药数量的增加，衰老对潜在 DDI 患病率的影响也随之增加。在仔细考虑药物的益处和风险后，尤其是在老龄化人口中，可以通过最大限度地减少处方药物的数量来减少门诊患者潜在的 DDI。
Background: Polypharmacy is common in outpatients and has been identified as a major risk factor for drug-drug interactions (DDIs), which are an important cause of adverse drug reactions. There has been a rapid increase in the number of elderly patients worldwide. However, there have been few studies quantifying the impact of both patient age and the number of concomitant drugs prescribed on the probability of potential DDIs per person in general outpatients.Objective: To assess the extent to which polypharmacy and aging are associated with potential DDIs in outpatients at a medical centre in Taiwan.Methods: The medications of 81 650 outpatients who visited a medical centre in Taiwan between January 2004 and March 2004 were retrospectively screened for potential DDIs using a computerized drug-interaction program. The main inclusion criteria were a minimum of two drug prescriptions and duration of use of 14 or more days. We also analysed the DDI pattern, which included severity, level of documentation and onset of potential DDIs, and assessed the impact of the number of drugs prescribed and of aging on the prevalence of potential DDIs per person.Results: The prevalence of potential DDIs was 25.6% (20 902 of 81 650). The mean +/- SD age of the 20 902 patients with potential DDIs was 57.5 +/- 16.5 years, and 47.6% of these patients were male. The mean +/- SD number of prescribed drugs in patients with potential DDIs was 5.8 +/- 2.4, and 67.7% of these patients were prescribed more than four drugs. The majority (55.7%) of DDIs were of the C2 pattern (severity: moderate; documentation: probable). The prevalence of potential DDIs increased in a linear mode with increasing age (p < 0.001) and with the number of drugs prescribed (p < 0.001); furthermore, in addition to being independently associated with potential DDIs, these two factors interacted to increase the risk further.Conclusions: This study showed that approximately one-quarter of 81 650 outpatients who visited a medical centre in Taiwan over a period of 3 months in 2004 had potential DDIs. We observed independent increases in potential DDIs per person in association with aging and increasing number of prescribed drugs. Furthermore, a significant interaction between these two factors was observed: the effect of aging on the prevalence of potential DDIs increased as the number of prescribed drugs increased. Potential DDIs in outpatients can be reduced by minimizing the number of drugs prescribed following careful consideration of both their benefits and risks, particularly in the aging population.