Optimising drug treatment for elderly people: the prescribing cascade
Optimising drug treatment for elderly people: the prescribing cascade
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DOI：
10.1136/bmj.315.7115.1096
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发表时间：
1997-10-25
影响因子：
105.7
通讯作者：
Gurwitz, JH
中科院分区：
文献类型：
--
作者：
Rochon, PA;Gurwitz, JH
医生进行的最常见的医疗干预是开处方。由于慢性病随着年龄的增长而增加，老年人更有可能患有需要药物治疗的疾病。高龄、虚弱和药物使用增加都是导致患者发生药物相关问题风险的因素。在美国，多达28%的老年人住院是由于药物相关问题，其中高达70%归因于药物不良反应。1制定最佳的药物方案来满足老年人的复杂需求需要深思熟虑和仔细规划。不适当的处方是昂贵的。在最近的一项研究中，在美国两家大型教学医院中，住院期间发生的可预防的药物不良事件（即药物相关医疗干预造成的伤害）的成本估计为每年280万美元（1.75英镑）。2管理不当处方后果的国家成本仍然不确定。据估计，每年门诊与药物相关的发病率和死亡率的成本为766亿美元。3.与药物有关的发病率和死亡率是一个重要的目标领域，既要提高老年人的医疗保健质量，又要降低老年人的保健费用。
The most frequent medical intervention performed by a doctor is the writing of a prescription. Because chronic illness increases with advancing age, older people are more likely to have conditions that require drug treatment. Advanced age, frailty, and increased use of drugs are all factors that contribute to a patient's risk of developing a drug related problem. As many as 28% of hospital admissions in the United States of older people are as a result of drug related problems, 1 up to 70% of which are attributed to adverse reactions to drugs. 1 Creating optimal drug regimens that meet the complex needs of elderly people requires thought and careful planning.Inappropriate prescribing is expensive. In a recent study the costs of preventable adverse drug events—namely, injury resulting from a drug related medical intervention—occurring during a stay in hospital were estimated to be $2.8 m (£ 1.75) annually in two large American teaching hospitals. 2 The national cost of managing the consequences of inappropriate prescribing remains uncertain. One estimate has put the annual cost of drug related morbidity and mortality in outpatient clinics at $76.6 bn. 3 Drug related morbidity and mortality is an important area to target both to improve the quality of medical care for elderly people and to reduce the costs of health care for this population.