Prevalence and predictors of polypharmacy among older primary care patients in Germany
Prevalence and predictors of polypharmacy among older primary care patients in Germany
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DOI：
10.1093/fampra/cml067
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发表时间：
2007-02-01
期刊：
影响因子：
2.2
通讯作者：
Hummers-Pradier, E.
中科院分区：
文献类型：
--
作者：
Junius-Walker, U.;Theile, G.;Hummers-Pradier, E.
背景。老年人消耗越来越多的药物。多种用药与导致住院甚至死亡的不良健康结果风险增加有关。描述在社区生活的老年全科患者中处方和非处方（OTC）药物的流行情况。从各种患者和医生相关因素中确定多药（五种或五种以上处方药）的预测因素。在德国两个地区随机选择67家诊所和466名老年患者（70岁以上）进行老年评估研究。对健康问题、全科医生的认识及其干预措施进行了横断面分析。在这个事后分析中，我们评估了老年患者报告的药物使用情况，并将其与医生对各自患者的药物治疗方案进行了比较。通过对患者健康和幸福感的详细评估，我们可以利用logistic回归分析和正向选择来探索多种多药治疗的预测因素。研究参与者平均服用3.7种处方药和1.4种非处方药。总的来说，26.7%的患者使用五种及以上的长期处方药。5个决定因素最能预测多药：呼吸困难、高血压、日常生活依赖器械活动、主观健康水平低和医患用药不一致。在德国，这一年龄较大的全科医生群体是欧洲研究样本中最高的药物用户群体之一。除了疾病特异性决定因素外，全科医生应该意识到，主观健康水平低和用药不一致是多种用药的独立预测因素。
Background. Older people consume an increasing amount of medication. Polypharmacy is associated with an elevated risk of adverse health outcomes resulting in hospitalizations and sometimes death.Objectives. To describe the prevalence of prescribed and over-the-counter (OTC) medications among older general practice patients living in the community. To determine predictors of polypharmacy (five or more prescribed drugs) from a variety of patient- and doctor-related factors.Methods. Sixty-seven randomly selected practices in two areas of Germany and 466 of their older patients (70+ years) were recruited for a geriatric assessment study. A cross-sectional analysis of health problems, GPs' awareness and their interventions was conducted. In this post hoc analysis, we assessed the medication use as reported by older patients and compared it with doctors' perceived medication regimens for their respective patients. The detailed assessment of patients' health and well-being enabled us to explore a variety of predictors of polypharmacy using logistic regression analysis with forward selection.Results. Study participants consumed an average of 3.7 prescribed medicines and an additional 1.4 OTC drugs. In all, 26.7% of patients used five and more chronically prescribed drugs. A set of five determinants predicted polypharmacy best: breathlessness, hypertension, dependency on instrumental activities of daily living, low subjective health and medication disagreement between doctors and patients.Conclusion. This older general practice population in Germany is among the top pharmaceutical user group of European study samples. Apart from disease-specific determinants, GPs should be aware that low subjective health and medication disagreement are independent predictors of polypharmacy.