Trends in Prevalence and Determinants of Potentially Inappropriate Prescribing in the United States: 2007 to 2012.
Trends in Prevalence and Determinants of Potentially Inappropriate Prescribing in the United States: 2007 to 2012.
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DOI：
10.1111/jgs.14077
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发表时间：
2016-04
影响因子：
6.3
通讯作者：
Stürmer T
中科院分区：
文献类型：
--
作者：
Jirón M;Pate V;Hanson LC;Lund JL;Jonsson Funk M;Stürmer T
使用2012年Beers标准估计美国老年人中潜在不适当处方（PIP）的患病率和决定因素。回顾性队列研究，随机抽样的国家医疗保险受益人。2007-2012年按服务收费的医疗保险受益人。年龄>65岁的美国人群，在一个日历年内至少入组1个月的A、B和D部分（N= 38，250例患者; 1，308，116次观察）我们使用2012年Beers标准，使用前12个月内的诊断或疾病数据，估计每个日历月内和12个月内≥1例PIP的患病率。为了解释在估计95%置信区间（CI）时单个人的多个月观察值的相关性，我们使用了广义估计方程。我们使用逻辑回归来确定PIP的独立决定因素。PIP的点患病率从2007年的37.6%（95%CI：37.0-38.1）下降至2012年的34.2%（95%CI：33.6-34.7），假设呈线性趋势，每年下降2%（95%CI：1-3%），具有统计学显著性。一年期流行率从2007年的64.9%下降到2012年的56.6%。PIP最强的预测因素是分发的药物数量。70岁或以上的人和老年病医生看到的人不太可能接受PIP。从2007年到2012年，PIP在美国老年人中的患病率根据2012年Beers标准有所下降，但仍然很高，每月仍有三分之一的人患病，12个月内有一半以上的人患病。处方的数量可用于确定未来干预措施的目标。
To estimate prevalence and determinants of potentially inappropriate prescribing (PIP) among US older adults using 2012 Beers criteria. Retrospective cohort study in a random national sample of Medicare beneficiaries. 2007–2012 fee-for-service Medicare beneficiaries. US population aged >65 years with Part A, B and D enrollment in at least 1 month during a calendar year (N=38,250 patients; 1,308,116 observations) We used 2012 Beers criteria to estimate the prevalence of ≥1 PIP within each calendar month and over a 12-month period using data on diagnoses or conditions present in the previous 12 months. To account for the dependence of multiple monthly observations of a single person when estimating 95% confidence intervals (CI) we used generalized estimating equations. We used logistic regression to identify independent determinants of PIP. The point-prevalence of PIP decreased from 37.6% (95%CI: 37.0–38.1) in 2007 to 34.2% (95%CI: 33.6–34.7) in 2012, with a statistically significant 2% (95%CI: 1–3%) decline per year assuming a linear trend. One year period-prevalence declined from 64.9% in 2007 to 56.6% in 2012. The strongest predictor of PIP was the number of drugs dispensed. Individuals aged 70 years or older and those seen by a geriatrician were less likely to receive PIP. From 2007 to 2012, the prevalence of PIP in US older adults decreased according to 2012 Beers criteria but remains high, still affecting a third each month and more than a half over 12 months. The number of dispensed prescription could be used to target future interventions.