Potentially inappropriate among elderly home medication use care patients in Europe
Potentially inappropriate among elderly home medication use care patients in Europe
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DOI：
10.1001/jama.293.11.1348
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发表时间：
2005-03-16
影响因子：
120.7
通讯作者：
Bernabei, R
中科院分区：
文献类型：
--
作者：
Fialová, D;Topinková, E;Bernabei, R
在过去的十年中，美国大型流行病学调查中使用了老年患者中潜在不适当用药的背景标准，以识别处于危险中的人群，并特别针对风险管理策略。目的评估欧洲老年家庭护理患者潜在不当用药的患病率和相关因素。设计、设置和参与者对在捷克共和国、丹麦、芬兰、冰岛、意大利、荷兰、挪威和英国的大都市地区登记的2707名接受家庭护理的老年患者(平均年龄为82.2[7.2]岁)进行回顾性横断面研究。在2001年9月至2002年1月期间，使用家庭护理工具中设置的最低数据对患者进行了前瞻性评估。主要结果指标使用所有专家小组关于社区老年人的标准(Beers和McLeod)记录了潜在不适当用药的流行率。结果结合所有3组标准，我们发现19.8%的患者使用了至少一种不适当的药物；使用1997年的旧标准，这一比例为9.8%至10.9%。东欧(捷克共和国的41.1%)和西欧(平均15.8%，从丹麦的5.8%到意大利的26.5%)之间有很大的差异。潜在的不当用药与患者的不良经济状况(调整后的相对风险[RR]，1.96；95%可信区间[CI]，1.58-2.36)、多药联营(RR，1.91；95%CI，1.62-2.22)、抗焦虑药物的使用(RR，1.82；95%CI，1.51-2.15)和抑郁(RR，1.29；95%CI，1.06-1.55)有关。负相关因素有年龄85岁及以上(RR，0.78；95%CI，0.65~0.92)和独居(RR，0.76；95%CI，0.64~0.89)。潜在不适当用药的几率随着相关因素的增多而显著增加(P
Context Criteria for potentially inappropriate medication use among elderly patients have been used in the past decade in large US epidemiological surveys to identify populations at risk and specifically target risk-management strategies. In contrast, in Europe little information is available about potentially inappropriate medication use and is based on small studies with uncertain generalizability.Objective To estimate the prevalence and associated factors of potentially inappropriate medication use among elderly home care patients in European countries.Design, Setting, and Participants Retrospective cross-sectional study of 2707 elderly patients receiving home care (mean [SDI age, 82.2 [7.2] years) representatively enrolled in metropolitan areas of the Czech Republic, Denmark, Finland, Iceland, Italy, the Netherlands, Norway, and the United Kingdom. Patients were prospectively assessed between September 2001 and January 2002 using the Minimum Data Set in Home Care instrument.Main Outcome Measures Prevalence of potentially inappropriate medication use was documented using all expert panels criteria for community-living elderly persons (Beers and McLeod). Patient-related characteristics independently associated with inappropriate medication use were identified with a multiple logistic regression model.Results Combining all 3 sets of criteria, we found that 19.8% of patients in the total sample used at least 1 inappropriate medication; using older 1997 criteria it was 9.8% to 10.9%. Substantial differences were documented between Eastern Europe (41.1% in the Czech Republic) and Western Europe (mean 15.8%, ranging from 5.8% in Denmark to 26.5% in Italy). Potentially inappropriate medication use was associated with patient's poor economic situation (adjusted relative risk [RR], 1.96; 95% confidence interval [CI], 1.58-2.36), polypharmacy (RR, 1.91; 95% Cl, 1.62-2.22), anxiolytic drug use (RR, 1.82; 95% Cl, 1.51-2.15), and depression (RR, 1.29; 95% Cl, 1.06-1.55). Negatively associated factors were age 85 years and older (RR, 0.78; 95% Cl, 0.65-0.92) and living alone (RR, 0.76; 95% Cl, 0.64-0.89). The odds of potentially inappropriate medication use significantly increased with the number of associated factors (P