Potentially Inappropriate Prescribing Among People with Dementia in Primary Care: A Retrospective Cross-Sectional Study Using the Enhanced Prescribing Database
Potentially Inappropriate Prescribing Among People with Dementia in Primary Care: A Retrospective Cross-Sectional Study Using the Enhanced Prescribing Database
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DOI：
10.3233/jad-151177
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发表时间：
2016-01-01
影响因子：
4
通讯作者：
Hughes, Carmel M.
中科院分区：
文献类型：
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作者：
Barry, Heather E.;Cooper, Janine A.;Hughes, Carmel M.
背景资料：关于社区居住的痴呆症患者（PWD）的处方适当性知之甚少。Objective：估计北方爱尔兰初级保健中PWD的潜在不适当处方（PIP）患病率，并调查PIP，多药，年龄和性别之间的关联。如果在2013年1月1日至2013年12月31日期间向患者分发了适用于痴呆症管理的药物，则患者合格。多重用药指的是使用≥ 4种不同药物组的重复药物。一个子集的筛选工具的老年人可能不适当的处方（STOPP）的标准，包括36个指标，适用于数据集。PIP的总体患病率和每个STOPP标准的患病率计算为数据集中所有合格人员的比例。Logistic回归分析被用来调查PIP，多药，年龄和性别之间的关联。在81.5%（n = 5564）的患者中观察到多种药物。研究期间PIP患病率为64.4%（95% CI 63.2-65.5; n = 4393）。PIP最常见的情况是使用抗胆碱能/抗毒蕈碱药物（25.2%; 95% CI 24.2-26.2; n = 1718）。在多变量分析中，多种药物和性别（女性）与PIP相关，比值比分别为7.6（95%CI 6.6-8.7）和1.3（95%CI 1.2-1.4）。PIP和年龄之间没有观察到关联，调整后的性别和polypharmacy.Conclusion：本研究确定了一个高患病率的PIP在社区居住的PWD。未来的干预措施可能需要侧重于某些治疗类别和多种药物。
Background: Little is known about prescribing appropriateness for community-dwelling people with dementia (PWD).Objective: To estimate potentially inappropriate prescribing (PIP) prevalence among PWD in primary care in Northern Ireland, and to investigate associations between PIP, polypharmacy, age, and gender.Methods: A retrospective cross-sectional study was conducted, using data from the Enhanced Prescribing Database. Patients were eligible if a medicine indicated for dementia management was dispensed to them during 1 January 2013-31 December 2013. Polypharmacy was indicated by use of >= 4 repeat medications from different drug groups. A subset of the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria, comprising 36 indicators, was applied to the dataset. Overall prevalence of PIP and the prevalence per each STOPP criterion was calculated as a proportion of all eligible persons in the dataset. Logistic regression was used to investigate associations between PIP, polypharmacy, age, and gender.Results: The study population comprised 6826 patients. Polypharmacy was observed in 81.5% (n = 5564) of patients. PIP prevalence during the study period was 64.4% (95% CI 63.2-65.5; n = 4393). The most common instance of PIP was the use of anticholinergic/antimuscarinic medications (25.2%; 95% CI 24.2-26.2; n = 1718). In multivariable analyses, both polypharmacy and gender (being female) were associated with PIP, with odds ratios of 7.6 (95% CI 6.6-8.7) and 1.3 (95% CI 1.2-1.4), respectively. No association was observed between PIP and age, after adjustments for gender and polypharmacy.Conclusion: This study identified a high prevalence of PIP in community-dwelling PWD. Future interventions may need to focus on certain therapeutic categories and polypharmacy.