Inappropriate medication administration to the acutely ill elderly: A nationwide emergency department study, 1992-2000
Inappropriate medication administration to the acutely ill elderly: A nationwide emergency department study, 1992-2000
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DOI：
10.1111/j.1532-5415.2004.52503.x
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发表时间：
2004-11-01
影响因子：
6.3
通讯作者：
Camargo, CA
中科院分区：
文献类型：
--
作者：
Caterino, JM;Emond, JA;Camargo, CA
目的：确定全国老年急诊科 (ED) 患者用药不当的比率和趋势。次要目标是确定接受不适当药物治疗的风险因素，并根据诊断确定用药有时是否合理。设计：对 1992-2000 年全国医院流动医疗调查中急诊室就诊的回顾性分析。使用 Beers 1997 年明确标准确定不适当药物。地点：美国非机构化综合医院和短期住院医院的急诊室。参与者：急诊室调查 65 岁及以上的患者。测量：36 种药物的使用量和比率。结果：估计有 1610 万人（95% 置信区间 (CI)=14.9-1730 万人）或 12.6% 服用了不适当药物。 (95% CI=11.6-13.5%) 1992 年至 2000 年急诊科就诊的老年人。在整个研究期间，不适当给药率没有变化 (P=.40)。占不当用药比例70.8%的有六种药物：异丙嗪（22.2%）、哌替啶（18.0%）、丙氧芬（17.2%）、羟嗪（10.3%）、苯海拉明（7.1%）、地西泮（6.0%）。在多变量分析中，ED 药物的数量是最强的预测因素，两到三种药物的比值比为 6.0 (95% CI=5.3-6.7)，四到六种药物的比值比为 8.1 (95% CI=7.2-9.2)。很少有诊断表明这些药物可能适当使用。例如，只有 42.4% 接受苯海拉明治疗的患者和 7.4% 接受羟嗪治疗的患者被诊断为过敏过程。结论：老年 ED 患者经常服用不适当的药物。通常不适当的药物的潜在适当用途不能解释此类给药。尽管 1997 年公布了明确的标准，但不当管理率仍然没有变化。
Objectives: To determine the national rate and trend of inappropriate medication administration to elderly emergency department (ED) patients. Secondary objectives were to identify risk factors for receiving an inappropriate medication and to determine whether administration is sometimes justified based on diagnosis.Design: Retrospective analysis of ED visits in the 1992-2000 National Hospital Ambulatory Medical Care Survey. Inappropriate medications identified using Beers' 1997 explicit criteria.Setting: EDs of U.S. noninstitutionalized general and short-stay hospitals.Participants: ED survey patients aged 65 and older.Measurements: Magnitude and rate of administration of 36 medications.Results: Inappropriate medications were administered in an estimated 16.1 million (95% confidence interval (CI)=14.9-17.3 million) or 12.6% (95% CI=11.6-13.5%) of elderly ED visits from 1992 to 2000. The rate of inappropriate administration was unchanged throughout the study period (P=.40). Six drugs accounted for 70.8% of inappropriate administration: promethazine (22.2%), meperidine (18.0%), propoxyphene (17.2%), hydroxyzine (10.3%), diphenhydramine (7.1%), and diazepam (6.0%). In multivariate analysis, number of ED medications was the strongest predictor, with an odds ratio for two to three medications of 6.0 (95% CI=5.3-6.7) and for four to six medications of 8.1 (95% CI=7.2-9.2). Diagnoses indicating potentially appropriate uses of these medications were rarely present. For example, only 42.4% of patients receiving diphenhydramine and 7.4% receiving hydroxyzine were diagnosed with an allergic process.Conclusion: Elderly ED patients are frequently administered inappropriate medications. Potentially appropriate uses of generally inappropriate drugs cannot account for such administrations. Inappropriate administration rates remain unchanged despite the 1997 publication of explicit criteria.