Inappropriate Prescribing Predicts Adverse Drug Events in Older Adults
Inappropriate Prescribing Predicts Adverse Drug Events in Older Adults
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DOI：
10.1345/aph.1m657
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发表时间：
2010-06-01
影响因子：
2.9
通讯作者：
Kaboli, Peter J.
中科院分区：
文献类型：
--
作者：
Lund, Brian C.;Carnahan, Ryan M.;Kaboli, Peter J.
背景技术背景：潜在不适当处方的明确措施，如Beers标准，与药物不良事件（ADE）的风险相关。然而，没有这样的链接已经建立了实际不适当的处方使用implicit measurements.OBJECTIVE：要确定是否一个隐含的措施不适当的处方可以预测ADE risk.METHODS：患者是退伍军人年龄65岁及以上的人被认为是在初级保健诊所和参加了一个随机对照试验的药剂师，医生的协作干预。不适当的处方是在基线确定的，使用2003年啤酒标准作为一个明确的措施和药物适当性指数（MAI）作为一个隐含的措施。设计了改良的MAI评分方法，以针对ADE风险，并在标准评分的基础上使用。基线后3个月内发生的ADE通过患者访谈和盲态药剂师审查的可行性验证进行评估。Logistic回归分析被用来确定是否不适当的处方预测风险的ADE，控制潜在的混杂factors.RESULTS：236例患者中，34例（14.4%）经历了ADE。在基线时，不适当的处方是常见的，48.7%的患者接受Beers标准药物，98.7%的患者至少有一个MAI标准的不适当评级。改良的MAI评分，而不是其他不适当的处方措施，显着预测ADE风险。改良MAI评分每增加一个单位（3.1 ± 3.5;平均SD），ADE的校正后3个月几率增加13%（OR 1.13; 95% CI 1.02 - 1.26）。例如，患者与修改后的MAI评分为3，接近精确的平均评分3.1，是在一个近40%的风险更大的ADE相比，患者的评分为zero.Conclusions：隐式测量实际不适当的处方预测ADE风险，一个重要的临床结果。这一发现有助于证实先前研究的有效性，这些研究依赖于明确的措施将潜在的不适当处方与不良健康结果联系起来。
BACKGROUND: Explicit measures of potentially inappropriate prescribing, such as the Beers criteria, have been associated with risk for adverse drug events (ADEs). However, no such link has been established for actual inappropriate prescribing using implicit measures.OBJECTIVE: To determine whether an implicit measure of inappropriate prescribing can predict ADE risk.METHODS: Patients were veterans aged 65 years and older who were seen in primary care clinics and participated in a randomized controlled trial of a pharmacist-physician collaborative intervention. Inappropriate prescribing was determined at baseline, using the 2003 Beers criteria as an explicit measure and the Medication Appropriateness Index (MAI) as an implicit measure. A modified MAI scoring approach was designed to target ADE risk and was used in addition to standard scoring. ADEs that occurred during the 3 months following baseline were assessed by patient interview and plausibility verification by blinded pharmacist review. Logistic regression analysis was used to determine whether inappropriate prescribing predicted risk for an ADE, controlling for potential confounding factors.RESULTS: Of 236 patients, 34 (14.4%) experienced an ADE. Inappropriate prescribing was common at baseline, with 48.7% of patients receiving a Beers criteria drug and 98.7% of patients having an inappropriate rating on at least 1 MAI criterion. Modified MAI scoring, but not other measures of inappropriate prescribing, significantly predicted ADE risk. For every unit increase in modified MAI score (3.1 +/- 3.5; mean SD), the adjusted 3-month odds of an ADE increased 13% (OR 1.13; 95% CI 1.02 to 1.26). For example, patients with a modified MAI score of 3, near the precise mean score of 3.1, were at a nearly 40% greater risk for an ADE compared with patients with a score of zero.CONCLUSIONS: Implicit measurement of actual inappropriate prescribing predicted ADE risk, an important clinical outcome. This finding helps confirm the validity of prior studies that have relied on explicit measures to link potentially inappropriate prescribing to adverse health outcomes.