INAPPROPRIATE PRESCRIBING AND RISK FACTORS IN ELDERLY

本研究建议进行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个人和组织系统因素，影响老年人不适当使用处方。 拟议的研究有三个具体目标：开发一个全面的基于人口的面板数据库处方药使用的全国代表性的老年人样本来自医疗支出面板调查（MEPS）。 该数据库将是MEPS药物样本与来自国家药物代码目录数据库的其他描述性药物信息匹配和增强的结果。记录一般和特定疾病队列中老年人不适当处方的最新国家模式和时间趋势。 将根据Bears（1997）制定的最新更新的明确标准评估老年人处方的不适当性。 在控制患者特征和疾病状况的两部分模型框架的背景下，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护理来源、保险类型和医疗护理组织特征。这项研究的设计有三个主要理由。 首先，不适当的预先描述导致了大量的药物不良事件（ADE），这占了大多数的医疗不良事件。 第二，老年人比年轻人患ADE的风险要高得多。 第三，现有的研究还没有令人满意地区分个人和组织的功能如何不同的可能性与数量的不适当的预描述在老年人。

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.