INAPPROPRIATE PRESCRIBING AND RISK FACTORS IN ELDERLY

本研究建议开展一项以全国人口为基础的试点研究，使用明确的标准来评估影响老年人处方不当使用的个人和组织系统因素。拟议的研究有三个具体目标：为来自医疗支出小组调查（MEPS）的具有全国代表性的老年人样本开发一个全面的基于人群的处方药物使用小组数据库。该数据库将是MEPS药物样本与国家药物代码目录数据库中附加的描述性药物信息进行匹配和扩充的结果。记录最新的全国老年人不适当处方的模式和时间趋势，包括一般人群和特定疾病人群。老年人处方的不适当性将由Bears（1997）制定的最新明确标准来评估。在控制患者特征和疾病条件的两部分模型框架下，分析个人和组织特征如何影响老年人不适当处方的概率和数量。组织结构将包括医疗和药房服务的药房来源、保险类型和医疗保健组织特征。这项研究设计有三个主要理由。首先，不恰当的预描述会导致大量药物不良事件（ADEs），这占医疗不良事件的大部分。其次，老年人患ADEs的风险比年轻人高得多。第三，现有的研究并没有令人满意地区分个体和组织特征对老年人不适当预描述的可能性和数量的不同贡献。

This research proposes to conduct a national population-based pilot study using explicit criteria to assess both individual and organizational system factors that affect inappropriate use of prescriptions in the elderly. The proposed research has three specific aims: To develop a comprehensive population-based panel database on prescribed medication use for a nationally representative elderly sample derived from the Medical Expenditure Panel Survey (MEPS). The database will be a result of matching and augmenting the MEPS medication sample with additional descriptive drug information from the National Drug Code Directory database. To document the most recent national patterns and time trend of inappropriate prescriptions in the elderly, for both general and disease- specific cohorts. The inappropriateness of prescriptions for the elderly will be assessed by the most recently updated explicit criteria developed by Bears (1997). To analyze how individual and organizational characteristics affect the probability as well as the quantity of inappropriate prescriptions by the elderly in the context of a two-part model framework controlling for patient characteristics and disease conditions. Organizational structures will include pharmacy sources of care for medical and pharmacy services, insurance type, and medical care organizational features. This study design is warranted on three major grounds. First, inappropriate predescribing contributes to substantial adverse drug events (ADEs), which account for a majority of medical adverse events. Second, elderly are at much higher risk for ADEs than younger people. Third, existing research has not satisfactorily distinguished how individual and organizational features contribute differently to the likelihood vs. The quantity of inappropriate predescribing in the elderly.