Beers Criteria as a Proxy for Inappropriate Prescribing of Other Medications Among Older Adults
Beers Criteria as a Proxy for Inappropriate Prescribing of Other Medications Among Older Adults
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DOI：
10.1345/aph.1q361
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发表时间：
2011-11-01
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.;Steinman, Michael A.;Kaboli, Peter J.
背景技术背景：Beers标准是一个汇编的药物被认为可能不适合老年人，广泛使用的处方quality indicator.OBJECTIVE：To determine whether Beers criteria serve as a proxy measure for other forms of inappropriate prescriptions，as measured by comprehensive implicit review.方法：65岁及以上患者的数据来自退伍军人事务部加强药房门诊（EPOC）和爱荷华州医疗补助药物病例管理（PCM）问题研究处方质量的综合测量进行了专家临床医生审查的医疗记录，根据药物适当性指数（MAI）。MAI评分归因于非啤酒药物进行了对比患者谁没有收到Beers标准medication.Results：啤酒标准药物占总MAI评分的12.9%（EPOC）和14.0%（PCM）。重要的是，在两项研究中，接受Beers标准药物治疗的患者的非Beers MAI评分显著较高（EPOC：15.1 vs 12.4，p = 0.02; PCM：11.1 vs 8.7，p = 0.04），调整重要混杂因素后。Beers标准的实用性扩展到直接测量有限的一组不适当的处方做法作为一个临床上有意义的代理其他不适当的做法。因此，使用处方质量指标来指导干预措施应该确定患者进行全面的药物审查，而不是确定具体的停药目标。未来的研究应探讨质量的测量和干预有针对性的应用比尔斯标准，特别是当与其他指标相结合。
BACKGROUND: The Beers criteria are a compilation of medications deemed potentially inappropriate for older adults, widely used as a prescribing quality indicator.OBJECTIVE: To determine whether Beers criteria serve as a proxy measure for other forms of inappropriate prescribing, as measured by comprehensive implicit review.METHODS: Data for patients 65 years and older were obtained from the Veterans Affairs Enhanced Pharmacy Outpatient Clinic (EPOC) and the Iowa Medicaid Pharmaceutical Case Management (PCM) studies. Comprehensive measurement of prescribing quality was conducted using expert clinician review of medical records according to the Medication Appropriateness Index (MAI). MAI scores attributable to non-Beers medications were contrasted between patients who did and did not receive a Beers criteria medication.RESULTS: Beers criteria medications accounted for 12.9% (EPOC) and 14.0% (PCM) of total MAI scores. Importantly, non-Beers MAI scores were significantly higher in patients receiving a Beers criteria medication in both studies (EPOC: 15.1 vs 12.4, p = 0.02; PCM: 11.1 vs 8.7, p = 0.04), after adjusting for important confounding factors.CONCLUSIONS: Beers criteria utility extended beyond direct measurement of a limited set of inappropriate prescribing practices by serving as a clinically meaningful proxy for other inappropriate practices. Using prescribing quality indicators to guide interventions should thus identify patients for comprehensive medication review, rather than identifying specific medication targets for discontinuation. Future research should explore both the quality measurement and the intervention targeting applications of the Beers criteria, particularly when integrated with other indicators.