Potentially Inappropriate Medication Prescribing in Outpatient Practices: Prevalence and Patient Characteristics Based on Electronic Health Records
Potentially Inappropriate Medication Prescribing in Outpatient Practices: Prevalence and Patient Characteristics Based on Electronic Health Records
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DOI：
10.1016/j.amjopharm.2009.03.001
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发表时间：
2009-04-01
期刊：
影响因子：
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通讯作者：
Wilcox, Adam B.
中科院分区：
文献类型：
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作者：
Buck, Michael D.;Atreja, Ashish;Wilcox, Adam B.
背景：一些老年人接受可能不适当的药物（PIM），增加了他们发生不良事件的风险。文献检索没有发现任何美国多中心研究，这些研究基于电子健康记录（EHR）的数据，使用Beers和Zhan标准测量了门诊实践中PIM的患病率。目的：本研究的目的是比较使用标准药物术语的PIM在2个不同机构使用EHR的患病率，并确定老年患者的PIM特征，方法：这项对2006年4月1日门诊患者的活性药物清单的横断面研究，使用来自2个门诊初级保健机构的数据进行：Intermountain Healthcare，盐湖，犹他州（中心1），和Cleveland Clinic，Cleveland，俄亥俄州（中心2）。数据来自年龄为：末次门诊访视时65岁且在过去2年内有≥ 2次记录的门诊访视的患者。主要终点是PIM的患病率，根据2002年Beers标准或2001年Zhan标准测量。结果：纳入61，251例患者的数据（36，663例女性，24，588例男性;中心1：37，247例患者;中心2：24，004例患者）。根据Beers标准，中心1和中心2分别有8693例（23.3%）和5528例（23.0%）患者记录为接受PIM;该差异无统计学显著性。根据Zhan标准（P < 0.001），这些值分别为6036（16.2%）和4160（17.3%）。两个机构中最常见的8种PIM是相同的，丙氧芬和氟西汀（每日一次）是最常见的处方药。女性，多药（>= 6药物），多个初级保健访问与PIM prescribing.Conclusions：在这2个门诊中心的老年患者的数据分析，一个小的一组8种药物占大多数的PIM在这两个中心，无论地理和人口的变化。女性、多种药物和初级保健就诊次数与PIM处方显著相关。(Am老年药理学杂志。2009;7：84-92）（C）2009 Excerpta Medica Inc.
Background: Some older adults receive potentially inappropriate medications (PIMs), increasing their risk for adverse events. A literature search did not find any US Multicenter Studies that measured the prevalence of PIMs in Outpatient practices based on data from electronic health records (EHRs), using both the Beers and Zhan criteria.Objectives: The aims of the present study were to compare the Prevalence of PIMs using standard drug terminologies at 2 disparate institutions using EHRs and to identify characteristics of elderly patients who have a PIM on their active-medication lists.Methods: This cross-sectional study of outpatients' active-medication lists from April 1, 2006, was conducted using data from 2 outpatient primary care settings: Intermountain Healthcare, Salt Lake City, Utah (center 1), and the Cleveland Clinic, Cleveland, Ohio (center 2). Data were included from patients who were aged :65 years at the time of the last office visit and had >= 2 documented clinic visits within the previous 2 years. The primary end point was Prevalence of PIMs, measured according to the 2002 Beers criteria or the 2001 Zhan criteria.Results: Data from 61,251 patients were included (36,663 women, 24,588 men; center 1: 37,247 patients; center 2: 24,004). A total of 8693 (23.3%) and 5528 (23.0%) patients at centers 1 and 2, respectively, were documented as receiving a PIM as per the Beers criteria; this difference was not statistically significant. Per the Zhan criteria (P < 0.001), these values were 6036 (16.2%) and 4160 (17.3%). Eight of the most common PIMs were the same at both institutions, with propoxyphene and fluoxetine (once daily) being the most prescribed. Female sex, polypharmacy (>= 6 medications), and multiple primary care visits were significantly associated with PIM prescribing.Conclusions: In this analysis of data from elderly patients at 2 outpatient centers, a small set of 8 medications accounted for the majority of PIMs at both centers, irrespective of geographic and demographic variations. Female sex, polypharmacy, and number of primary care visits were significantly associated with PIM prescribing. (Am J Geriatr Pharmacother. 2009;7:84-92) (C) 2009 Excerpta Medica Inc.