Potential Therapeutic Competition in Community-Living Older Adults in the US: Use of Medications That May Adversely Affect a Coexisting Condition
Potential Therapeutic Competition in Community-Living Older Adults in the US: Use of Medications That May Adversely Affect a Coexisting Condition
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DOI：
10.1371/journal.pone.0089447
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发表时间：
2014-02-25
期刊：
影响因子：
3.7
通讯作者：
Tinetti, Mary E.
中科院分区：
文献类型：
--
作者：
Lorgunpai, Songprod Jonathan;Grammas, Marianthe;Tinetti, Mary E.
目的：75%患有多种慢性病的老年人面临治疗竞争的风险(即针对一种疾病的治疗可能对共存疾病产生不利影响)。该研究的目的是确定潜在的治疗竞争在社区生活的老年人中的患病率。方法：对具有代表性的5,815名社区生活的老年人进行横断面描述性研究。S，2007年至2009年。至少接受一种药物治疗的14种最常见的慢性病是从医疗保险索赔中确定的。国家疾病指南中为这些疾病推荐并由2%的参与者使用的药物类别是从2008-2010年进行的面对面访谈中确定的。潜在治疗竞争的标准包括：1)公认的药物不良反应；2)在疾病指南中提及；或3)2000年以来发表的系统综述或两项研究中的报告。结果：在27种药物类别中，有15种(55.5%)的药物推荐用于一种研究条件可能会对其他研究条件产生不利影响。在91对可能的慢性疾病研究中，25对(27.5%)至少有一种潜在的治疗竞争。在参与者中，1,313人(22.6%)接受了至少一种可能加剧共存疾病的药物；753人(13%)有多对这样的竞争性疾病。例如，在846名患有高血压和慢性阻塞性肺病的参与者中，16.2%的人使用了非选择性β-受体阻滞剂。在37例潜在的治疗竞争中，只有6例(16.2%)与没有竞争条件的患者相比，具有竞争条件的患者接受药物治疗的可能性较小。结论：五分之一的美国老年人接受的药物可能会对共存条件产生不利影响。在这些情况下确定临床结果是一项研究和临床优先事项。在开药时，应考虑对共存条件的影响。
Objective: The 75% of older adults with multiple chronic conditions are at risk of therapeutic competition (i.e. treatment for one condition may adversely affect a coexisting condition). The objective was to determine the prevalence of potential therapeutic competition in community-living older adults.Methods: Cross-sectional descriptive study of a representative sample of 5,815 community-living adults 65 and older in the U. S, enrolled 2007-2009. The 14 most common chronic conditions treated with at least one medication were ascertained from Medicare claims. Medication classes recommended in national disease guidelines for these conditions and used by >= 2% of participants were identified from in-person interviews conducted 2008-2010. Criteria for potential therapeutic competition included: 1), well-acknowledged adverse medication effect; 2) mention in disease guidelines; or 3) report in a systematic review or two studies published since 2000. Outcomes included prevalence of situations of potential therapeutic competition and frequency of use of the medication in individuals with and without the competing condition.Results: Of 27 medication classes, 15 (55.5%) recommended for one study condition may adversely affect other study conditions. Among 91 possible pairs of study chronic conditions, 25 (27.5%) have at least one potential therapeutic competition. Among participants, 1,313 (22.6%) received at least one medication that may worsen a coexisting condition; 753 (13%) had multiple pairs of such competing conditions. For example, among 846 participants with hypertension and COPD, 16.2% used a nonselective beta-blocker. In only 6 of 37 cases (16.2%) of potential therapeutic competition were those with the competing condition less likely to receive the medication than those without the competing condition.Conclusions: One fifth of older Americans receive medications that may adversely affect coexisting conditions. Determining clinical outcomes in these situations is a research and clinical priority. Effects on coexisting conditions should be considered when prescribing medications.