American Journal Geriatric Pharmacotherapy最新文献_第6页

Trajectory Classes of Depression in a Randomized Depression Trial of Heart Failure Patients: A Reanalysis of the SADHART-CHF Trial 心衰患者随机抑郁试验中抑郁的轨迹分类:SADHART-CHF试验的再分析

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-12-01 DOI: 10.1016/j.amjopharm.2011.09.001

Maragatha N. Kuchibhatla PhD , Gerda G. Fillenbaum PhD

Objective

The objective of this article was to determine whether, in drug intervention trials, growth mixture modeling (GMM) is able to identify drug-responsive trajectory classes that are not evident in traditional growth modeling approaches.

Methods

We reanalyzed acute phase (biweekly data up to 7 occasions) and longitudinal (12 months) data on the 469 patients in the SADHART-CHF study of the safety and efficacy of sertraline for depression in patients with heart failure. GMM was used to identify the trajectory classes present in the treatment and placebo groups, based on Hamilton Depression Rating Scale scores.

Results

Two distinct trajectory classes were identified in the treatment group: (1) chronic depressives (12%), who remained depressed through the treatment phase; and (2) responders (88%), who had scores indicating nondepression at the conclusion of the acute phase. At baseline, chronic depressives were distinguished by higher Hamilton Depression Rating Scale scores, the presence of implantable cardioverter defibrillators, and a history of anxiety. During follow-up, they were more likely to have unstable angina. Only responders remitted (70%). Three distinct trajectories were identified in the placebo group: (1) moderating depressives (19%), (2) temporary improvers (13%), and (3) responders (68%). At baseline, the classes differed in mean Hamilton Depression Rating Scale scores, responders' scores falling between the other 2 classes, and the proportion with renal disease. Only remission differed at follow-up: responders (76%), moderating depressives (21%), and temporary improvers (3%). Where the traditional analytic approach found improvement from moderate to mild depression but no significant treatment effect, GMM found response in 20% more people in the treatment group than in the placebo group.

Conclusions

Unlike conventionally used, standard analytic approaches, which focus on intervention impact at study end or change from baseline to study end, GMM enables maximum use of repeated data to identify unique trajectories of latent classes that are responsive to the intervention. ClinicalTrials.gov identifier: NCT00078286.

本文的目的是确定在药物干预试验中，生长混合物模型(GMM)是否能够识别传统生长模型方法中不明显的药物反应轨迹类别。方法:我们重新分析了SADHART-CHF研究中469例患者的急性期(最多7次)和纵向(12个月)数据，以研究舍曲林治疗心力衰竭患者抑郁的安全性和有效性。基于汉密尔顿抑郁评定量表得分，GMM用于确定治疗组和安慰剂组中存在的轨迹类别。结果治疗组有两个明显的轨迹类别:(1)慢性抑郁症患者(12%)，在整个治疗阶段仍保持抑郁状态;(2)有反应者(88%)，他们在急性期结束时得分表明无抑郁。在基线时，慢性抑郁症的特点是汉密尔顿抑郁评定量表得分较高，存在植入式心律转复除颤器，并有焦虑史。在随访期间，他们更有可能患有不稳定型心绞痛。只有应答者回复(70%)。在安慰剂组中确定了三个不同的轨迹:(1)抑郁症缓解(19%)，(2)暂时改善(13%)，(3)缓解(68%)。基线时，两类患者的汉密尔顿抑郁评定量表平均得分不同，应答者的得分介于其他两类之间，肾病患者的比例也不同。只有缓解在随访中有所不同:反应者(76%)，抑郁缓和者(21%)和暂时改善者(3%)。传统的分析方法发现从中度到轻度抑郁症有所改善，但没有显著的治疗效果，GMM发现治疗组的反应比安慰剂组多20%。与传统使用的标准分析方法不同，GMM侧重于研究结束时的干预影响或从基线到研究结束的变化，它可以最大限度地利用重复数据来确定对干预有反应的潜在类别的独特轨迹。ClinicalTrials.gov识别码:NCT00078286。

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引用次数: 12

Potentially Harmful Drug–Drug Interactions in the Elderly: A Review 老年人中潜在有害的药物-药物相互作用:综述

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-12-01 DOI: 10.1016/j.amjopharm.2011.10.004

Lisa E. Hines PharmD , John E. Murphy PharmD

Background

Elderly patients are vulnerable to drug interactions because of age-related physiologic changes, an increased risk for disease associated with aging, and the consequent increase in medication use.

Objective

The purpose of this narrative review was to describe findings from rigorously designed observational cohort and case-control studies that have assessed specific drug interactions in elderly patients.

Methods

The PubMed and International Pharmaceutical Abstracts databases were searched for studies published in English over the past 10 years (December 2000–December 2010) using relevant Medical Subject Headings terms (aged; aged, 80 and over; and drug interactions) and search terms (drug interaction and elderly). Search strategies were saved and repeated through September 2011 to ensure that the most recent relevant published articles were identified. Additional articles were found using a search of review articles and reference lists of the identified studies. Studies were included if they were observational cohort or case-control studies that reported specific adverse drug interactions, included patients aged ≥65 years, and evaluated clinically meaningful end points. Studies were excluded if they used less rigorous observational designs, assessed pharmacokinetic/pharmacodynamic properties, evaluated drug-nutrient or drug-disease interactions or interactions of drug combinations used for therapeutic benefit (eg, dual antiplatelet therapy), or had inconclusive evidence.

Results

Seventeen studies met the inclusion criteria. Sixteen studies reported an elevated risk for hospitalization in older adults associated with adverse drug interactions. The drug interactions included: angiotensin-converting enzyme (ACE) inhibitors and potassium-sparing diuretics, ACE inhibitors or angiotensin receptor blockers and sulfamethoxazole/trimethoprim, benzodiazepines or zolpidem and interacting medications, calcium channel blockers and macrolide antibiotics, digoxin and macrolide antibiotics, lithium and loop diuretics or ACE inhibitors, phenytoin and sulfamethoxazole/trimethoprim, sulfonylureas and antimicrobial agents, theophylline and ciprofloxacin, and warfarin and antimicrobial agents or nonsteroidal anti-inflammatory drugs. One study reported the risk for breast cancer-related death as a function of paroxetine exposure among women treated with tamoxifen.

Conclusions

Several population-based studies have reported significant harm associated drug interactions in elderly patients. Increased awareness and interventions aimed at reducing exposure and minimizing the risks associated with potentially harmful drug combinations are needed.

背景:由于与年龄相关的生理变化、与衰老相关的疾病风险增加以及随之而来的药物使用增加，老年患者容易受到药物相互作用的影响。目的:本叙述性综述的目的是描述严格设计的观察性队列研究和病例对照研究的结果，这些研究评估了老年患者的特定药物相互作用。方法检索PubMed和国际药学文摘数据库中过去10年(2000年12月- 2010年12月)用相关医学主题词发表的英文研究(年龄;80岁及以上;以及药物相互作用)和搜索词(药物相互作用和老年人)。搜索策略被保存并重复到2011年9月，以确保确定最新的相关发表文章。通过检索已确定研究的综述文章和参考文献列表，发现了其他文章。如果研究是观察性队列研究或病例对照研究，报告了特定的药物不良反应，包括年龄≥65岁的患者，并评估了临床有意义的终点，则纳入研究。如果研究采用不太严格的观察设计，评估了药代动力学/药效学特性，评估了药物-营养物质或药物-疾病相互作用或用于治疗益处的药物组合的相互作用(例如，双重抗血小板治疗)，或证据不确定，则排除研究。结果17项研究符合纳入标准。16项研究报告了与不良药物相互作用相关的老年人住院风险升高。药物相互作用包括:血管紧张素转换酶(ACE)抑制剂和保钾利尿剂、ACE抑制剂或血管紧张素受体阻滞剂和磺胺甲恶唑/甲氧苄啶、苯二氮卓类或唑吡坦和相互作用药物、钙通道阻滞剂和大环内酯类抗生素、地高辛和大环内酯类抗生素、锂和环利尿剂或ACE抑制剂、苯妥英和磺胺甲恶唑/甲氧苄啶、磺酰脲类和抗菌剂、茶碱和环丙沙星、华法林和抗菌剂或非甾体抗炎药。一项研究报告说，在接受他莫昔芬治疗的妇女中，帕罗西汀暴露与乳腺癌相关死亡的风险有关。结论:几项基于人群的研究报告了老年患者药物相互作用的显著危害。需要提高认识并采取干预措施，以减少接触和尽量减少与潜在有害药物组合有关的风险。

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引用次数: 248

A Note of Thanks 感谢信

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-12-01 DOI: 10.1016/j.amjopharm.2011.11.002

引用次数: 0

Streptococcus pneumoniae Vaccination in Older Adults 老年人肺炎链球菌疫苗接种

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-12-01 DOI: 10.1016/j.amjopharm.2011.09.008

Elizabeth Rightmier PharmD , Vanessa Stevens PhD , Jack Brown PharmD, MS

Background

Streptococcus pneumoniae infections are a major cause of morbidity and mortality in older adults. Vaccination in older adults is intended to prevent S pneumoniae infections, yet little information is available regarding its efficacy in this patient population.

Objective

The aim of this article was to review the current literature to determine the efficacy and tolerability of S pneumoniae vaccination in older adults.

Methods

PubMed (1950–present) and EMBASE (1974–present) were searched using the search terms Streptococcus pneumoniae immunization, pneumococcus immunization, pneumococcus vaccine, and aged. Additional articles were identified from the reference lists of included studies. Studies were included if they reported information in older (55–<65 years) and elderly (≥65 years) adults and were related to at least 1 of the following topics: epidemiology of S pneumoniae, estimates of vaccine coverage, recommendations for vaccination, tolerability, and efficacy and/or effectiveness of vaccination against S pneumoniae.

Results

Six randomized controlled trials and 18 observational studies that evaluated the efficacy of pneumococcal vaccination in older and elderly adults were reviewed. Findings from evaluations of efficacy, as measured by clinical outcomes and immunogenicity, in older adults have been conflicting, with some subsets of prospective, well-controlled studies finding little benefit, whereas findings from several retrospective studies have suggested significant benefit. This discord may have been a result of the limited power of the prospective subanalyses to detect significant differences.

Conclusions

In light of the potential clinical benefit and few reports of serious adverse events, vaccination in older adults is likely warranted. Prospective, well-controlled studies are needed to better quantitatively evaluate the benefit of pneumococcal vaccine in older adults.

背景肺炎链球菌感染是老年人发病和死亡的主要原因。老年人接种疫苗的目的是预防肺炎链球菌感染，但关于其在这一患者群体中的有效性的信息很少。目的回顾目前的文献，以确定老年人肺炎链球菌疫苗接种的疗效和耐受性。方法采用肺炎链球菌免疫、肺炎球菌免疫、肺炎球菌疫苗、年龄等检索词对spubmed(1950 -至今)和EMBASE(1974 -至今)进行检索。从纳入研究的参考文献列表中确定了其他文章。如果研究报告了老年人(55 - 65岁)和老年人(≥65岁)的信息，并且与以下主题至少1项相关:肺炎链球菌流行病学、疫苗覆盖率估计、疫苗接种建议、耐受性、疫苗接种的有效性和/或有效性。结果回顾了6项随机对照试验和18项观察性研究，评估了老年人和老年人肺炎球菌疫苗接种的疗效。以临床结果和免疫原性衡量的疗效评估结果在老年人中存在矛盾，一些前瞻性、对照良好的研究亚组发现几乎没有益处，而一些回顾性研究的结果表明有显著益处。这种不一致可能是由于前瞻性亚分析检测显著差异的能力有限。结论鉴于潜在的临床益处和严重不良事件的报道较少，老年人接种疫苗可能是有必要的。需要前瞻性、对照良好的研究来更好地定量评估老年人接种肺炎球菌疫苗的益处。

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引用次数: 13

Drug Utilization Patterns and Cardiovascular Outcomes in Elderly Patients Newly Initiated on Atorvastatin or Simvastatin 新开始使用阿托伐他汀或辛伐他汀的老年患者的药物使用模式和心血管结局

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-12-01 DOI: 10.1016/j.amjopharm.2011.09.004

Jason P. Swindle PhD , Jesse Potash PhD , Mahesh Kulakodlu MS , Andreas Kuznik PhD , Ami Buikema MPH

Background

Hydroxymethylglutaryl coenzyme-A reductase inhibitors simvastatin and atorvastatin are effective at lowering LDL-C levels and reducing the risk of cardiovascular (CV) events.

Objective

The objective of this study was to examine differences in drug utilization and CV event risk among elderly patients newly initiated on simvastatin versus atorvastatin.

Methods

This was a retrospective analysis using pharmacy and medical claims from a US health plan database. Enrollees aged ≥65 years, newly initiated on simvastatin or atorvastatin (index drugs) from July 1, 2006 to November 30, 2008 were identified for study inclusion. Patients were excluded if they had any prescriptions for clopidogrel, nitrates, or other dyslipidemia medication, or any CV events before index drug initiation. Adherence was calculated by proportion of days covered with index medication. CV events (myocardial infarction, ischemic heart disease, cerebrovascular disease, peripheral vascular disease, aortic aneurysm, revascularization, or heart failure) were identified from medical claims.

Results

There were 11,470 atorvastatin initiators and 20,132 simvastatin initiators identified. Mean age of these patients was 72 years; 40% were male; nearly half had hypertension; and more than a quarter had diabetes. The majority of statin therapy (77%) was prescribed by primary care physicians. Forty-nine percent of atorvastatin patients were initiated on a 10 mg-dose and 61% of simvastatin patients on 5-, 10-, or 20-mg doses. A larger percentage of patients in the simvastatin cohort were adherent to index therapy than patients in the atorvastatin cohort (43% vs 36%, respectively). Multivariate regression adjusting for patient characteristics revealed no significant difference in CV events between patients receiving atorvastatin versus simvastatin.

Conclusions

In this study of elderly statin patients without recent evidence of CV events, the majority of patients started on low-dose therapy and did not achieve sufficient adherence. After controlling for patient and clinical characteristics, no statistically significant difference in risk of CV event was observed based on initiation with atorvastatin versus simvastatin.

羟甲基戊二酰辅酶a还原酶抑制剂辛伐他汀和阿托伐他汀在降低LDL-C水平和降低心血管(CV)事件风险方面有效。目的研究新开始服用辛伐他汀和阿托伐他汀的老年患者在药物使用和心血管事件风险方面的差异。方法回顾性分析美国健康计划数据库中的药房和医疗索赔。年龄≥65岁，2006年7月1日至2008年11月30日新开始使用辛伐他汀或阿托伐他汀(指标药物)的入组者被纳入研究。如果患者有氯吡格雷、硝酸盐或其他血脂异常药物的处方，或在指数药物开始前有任何CV事件，则排除。依从性以指标用药天数的比例计算。心血管事件(心肌梗死、缺血性心脏病、脑血管疾病、周围血管疾病、主动脉瘤、血运重建术或心力衰竭)从医疗索赔中确定。结果共鉴定出11470个阿托伐他汀起始剂和20132个辛伐他汀起始剂。患者平均年龄72岁;40%为男性;近一半的人患有高血压;超过四分之一的人患有糖尿病。大多数他汀类药物治疗(77%)是由初级保健医生开的。49%的阿托伐他汀患者起始剂量为10mg, 61%的辛伐他汀患者起始剂量为5mg、10mg或20mg。辛伐他汀组患者坚持指数治疗的比例高于阿托伐他汀组(分别为43%和36%)。对患者特征进行多因素回归调整后发现，接受阿托伐他汀和辛伐他汀治疗的患者在心血管事件方面没有显著差异。结论:在这项研究中，没有近期CV事件证据的老年他汀类药物患者中，大多数患者开始使用低剂量治疗，并且没有达到足够的依从性。在控制了患者和临床特征后，基于阿托伐他汀和辛伐他汀的起始治疗，没有观察到CV事件风险的统计学差异。

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引用次数: 13

Prevalence and Predictors of Anticholinergic Agents in Elderly Outpatients with Dementia 老年痴呆门诊患者抗胆碱能药物的患病率及预测因素

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-12-01 DOI: 10.1016/j.amjopharm.2011.10.001

Rituparna Bhattacharya MS , Satabdi Chatterjee MS , Ryan M. Carnahan PharmD, MS , Rajender R. Aparasu PhD, MPharm

Background

Anticholinergic medications, although frequently used in elderly populations, are associated with cognitive impairment and constitute significant concern for patients with dementia.

Objective

The purpose of our study was to examine patterns and predictors of prescribing anticholinergic agents for elderly outpatients with dementia.

Methods

We combined data from the 2006–2007 National Ambulatory Medical Care Survey and the outpatient department component of National Hospital Ambulatory Medical Care Survey to analyze patient visits by elderly persons (aged ≥65 years) with dementia. Anticholinergic drugs were identified using the Anticholinergic Drug Scale, which classifies anticholinergic drugs into four levels (0–3) in increasing order of anticholinergic activity. Descriptive analysis using sampling weights was used to evaluate patterns of anticholinergic drug prescription, especially prescribing of medications with clinically significant anticholinergic activity (ie, levels 2 or 3). Multiple logistic regression was used in the conceptual framework of the Andersen Behavioral Model to examine the predisposing, enabling, and need factors associated with prescribing of medications with clinically significant anticholinergic activity.

Results

According to the national surveys there were a total of 6.8 million (95% CI, 5.27–8.44 million; 0.32%) ambulatory care visits for dementia. Approximately 43% (42.86%; 95% CI, 35.24–50.48) of these visits involved prescribing at least one anticholinergic drug; and 10.07% of visits involved prescribing levels 2 or 3 anticholinergic medications. The predisposing factor, age (75–84 years; odds ratio [OR] = 0.25; 95% CI, 0.07–0.87), and the need factors, acetylcholinesterase inhibitor use (OR = 0.25; 95% CI, 0.07–0.86) and comorbid mood disorders (OR = 0.12; 95% CI, 0.02–0.73), were associated with decreased likelihood of prescribing medications with clinically significant anticholinergic activity. The need factor total number of medications prescribed (OR = 1.45, 95% CI, 1.20–1.75) increased the likelihood of these prescriptions being administered.

Conclusions

One in 10 outpatient visits by elderly persons with dementia involved prescribing medications with clinically significant anticholinergic activity. Given their adverse cognitive effects, there is a strong need to optimize anticholinergic drug prescribing in vulnerable elderly outpatients with dementia.

背景:抗胆碱能药物虽然经常用于老年人群，但与认知功能障碍有关，对痴呆患者构成重大关注。目的探讨老年痴呆门诊患者使用抗胆碱能药物的模式和预测因素。方法结合2006-2007年全国门诊医疗调查和全国医院门诊医疗调查的门诊部分数据，分析老年痴呆患者(年龄≥65岁)的就诊情况。采用《抗胆碱能药物量表》对抗胆碱能药物进行鉴定，该量表将抗胆碱能药物按照抗胆碱能活性的递增顺序分为4级(0-3级)。使用抽样权重的描述性分析来评估抗胆碱能药物处方模式，特别是处方具有临床显著抗胆碱能活性的药物(即2级或3级)。在Andersen行为模型的概念框架中使用多元逻辑回归来检查与处方具有临床显著抗胆碱能活性的药物相关的易感因素、使能因素和需求因素。结果全国调查共有680万例(95% CI, 527 - 844万;0.32%)痴呆症门诊就诊。约43% (42.86%;95% CI, 35.24-50.48)，这些就诊涉及处方至少一种抗胆碱能药物;10.07%的就诊涉及处方2级或3级抗胆碱能药物。易感因素:年龄(75-84岁);优势比[OR] = 0.25;95% CI, 0.07-0.87)，以及需要因素，乙酰胆碱酯酶抑制剂的使用(OR = 0.25;95% CI, 0.07-0.86)和共病性情绪障碍(OR = 0.12;95% CI, 0.02-0.73)，与处方具有临床显著抗胆碱能活性药物的可能性降低相关。处方药物的需求因子总数(OR = 1.45, 95% CI, 1.20-1.75)增加了这些处方被使用的可能性。结论:老年痴呆患者每10例门诊就诊中就有1例处方具有临床显著抗胆碱能活性的药物。鉴于其不利的认知影响，有强烈的需要优化抗胆碱能药物处方易受伤害的老年痴呆门诊患者。

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引用次数: 41

Medication Errors During Patient Transitions into Nursing Homes: Characteristics and Association With Patient Harm 在病人过渡到养老院的用药错误:特点和与病人伤害的关系

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-12-01 DOI: 10.1016/j.amjopharm.2011.10.005

Rishi Desai MS , Charlotte E. Williams MPH , Sandra B. Greene DrPH , Stephanie Pierson MSHI , Richard A. Hansen PhD

Background

Patients transitioning to a nursing home from their home or other facility are at high risk for medication errors.

Objective

Our aim was to describe characteristics of medication errors occurring during transitions to nursing homes, to compare characteristics of transition errors with errors not involving a transition, and to evaluate the impact of these errors on patient harm.

Methods

This was a cross-sectional analysis of individual medication error incidents reported by North Carolina nursing homes to the Medication Error Quality Initiative during fiscal years 2007 through 2009. Bivariate associations between errors in transition with patient factors, error-related factors, reported causes of errors, and impact on patients were tested using a χ² test. Multivariate logistic regression explored whether medication errors during transitions were more harmful than errors not occurring during transitions. Patient-related factors included in the model were age, sex, and cognitive ability. Error-related factors were primary type of error, process phase when error began, primary personnel involved, and an indicator for repeat error.

Results

A total of 27,759 individual medication error incidents were reported over a 3-year period in North Carolina nursing homes. Of these errors, 2919 incidents (11%) involved a patient transitioning to a nursing home. Errors involved in transitions were found to have higher odds of patient harm compared with errors not involved in transitions (odds ratio = 1.85; 95% CI, 1.30–2.63). Staff communication, order transcription, medication availability, pharmacy issues, and name confusion were particularly important contributors to medication errors during transitions (P < 0.05 for comparison with nontransition errors).

Conclusions

Transitions across care settings introduce risk for patient harm, and medication errors are an important area for improvement during transitions.

背景:从家中或其他机构转到养老院的患者发生用药错误的风险很高。我们的目的是描述过渡到养老院期间发生的用药错误的特征，比较过渡错误与不涉及过渡的错误的特征，并评估这些错误对患者伤害的影响。方法:本研究是对2007 - 2009财政年度北卡罗莱纳州养老院向“用药错误质量倡议”报告的个人用药错误事件进行横断面分析。使用χ2检验检验转诊错误与患者因素、错误相关因素、报告的错误原因和对患者的影响之间的双变量关联。多变量逻辑回归探讨过渡期间的用药错误是否比过渡期间未发生的用药错误更有害。模型中纳入的患者相关因素包括年龄、性别和认知能力。与错误相关的因素包括主要错误类型、错误开始的过程阶段、涉及的主要人员以及重复错误的指标。结果北卡罗莱纳州养老院在3年期间共报告了27,759起个人用药错误事件。在这些错误中，2919起事件(11%)涉及到病人转移到养老院。与不涉及转换的错误相比，涉及转换的错误对患者造成伤害的几率更高(优势比= 1.85;95% ci, 1.30-2.63)。员工沟通、订单转录、药物可用性、药房问题和名称混淆是导致过渡期间用药错误的特别重要因素(P <0.05与非过渡误差比较)。结论跨护理环境的转变会带来患者伤害的风险，药物错误是转变过程中需要改善的一个重要领域。

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引用次数: 40

Transient Impact of Automated Glomerular Filtration Rate Reporting on Drug Dosing for Hospitalized Older Adults With Concealed Renal Insufficiency 自动肾小球滤过率报告对隐蔽性肾功能不全住院老年人用药的短暂影响

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-10-01 DOI: 10.1016/j.amjopharm.2011.08.003

Jessica L. Kalender-Rich MD , Jonathan D. Mahnken PhD , James B. Wetmore MD , Sally K. Rigler MD, MPH

Background

Older adults with concealed renal insufficiency are at risk of medication dosing errors. It is not known whether automated estimated glomerular filtration rate (eGFR) reporting is associated with reduced dosing errors in this population.

Objective

The goal of the present study was to examine the impact on prescribing patterns in older adults with concealed renal insufficiency for a variety of renally cleared medications before and after the addition of automated eGFR reporting.

Methods

We performed a retrospective chart review at a single tertiary academic medical center among hospitalized patients aged ≥70 years with concealed renal insufficiency. Data were examined from the months of July, December, and May before and after the hospital initiated automated eGFR reporting, in 2006–2007 and 2008–2009, respectively. Doses of selected renally cleared medications were classified as appropriate or inappropriate on the basis of published recommendations. Regression models were used to identify demographic, clinical, and care factors associated with dosing appropriateness.

Results

Before implementation of automated eGFR reporting, we observed 260 persons in whom 42.2% of relevant prescriptions were inappropriately dosed; after implementation, there were 280 subjects in whom 36.6% of relevant prescriptions were inappropriately dosed. The multivariable model suggested an overall trend toward less inappropriate dosing after automated eGFR reporting began, compared with rates before (adjusted odds ratio [AOR] = 0.75 [95% confidence interval: 0.52–1.07], P = 0.11). However, a gradient was observed as the academic year progressed. A marked reduction in the rate of inappropriate medication dosing was seen in July after initiation of eGFR reporting compared with the July before initiation (AOR = 0.28; P < 0.01). This effect was attenuated in December (AOR = 0.45; P = 0.05) and gone by May (AOR = 0.85; P = 0.67).

Conclusion

Automated eGFR reporting alone, without any order entry intervention, was associated only transiently with improved dosing appropriateness for these older adults with concealed renal insufficiency.

背景:隐蔽性肾功能不全的老年人有用药剂量错误的风险。在这一人群中，自动估计肾小球滤过率(eGFR)报告是否与减少给药误差有关尚不清楚。本研究的目的是研究在增加自动eGFR报告之前和之后，各种肾脏清除药物对隐蔽性肾功能不全老年人处方模式的影响。方法回顾性分析某三级学术医疗中心年龄≥70岁隐蔽性肾功能不全住院患者的资料。在2006-2007年和2008-2009年医院启动eGFR自动化报告前后，分别检查了7月、12月和5月的数据。根据已发表的建议，将选定的肾脏清除药物的剂量划分为适当或不适当。回归模型用于确定与剂量适宜性相关的人口统计学、临床和护理因素。结果在实施eGFR自动化报告前，我们共观察260人，其中用药不当占42.2%;实施后，280名受试者中相关处方使用不当的比例为36.6%。多变量模型显示，与自动eGFR报告开始前相比，总体趋势是不适当的给药减少(调整优势比[AOR] = 0.75[95%置信区间:0.52-1.07]，P = 0.11)。然而，随着学年的进展，可以观察到一个梯度。与开始eGFR报告前的7月相比，开始eGFR报告后的7月用药不当率显著降低(AOR = 0.28;P & lt;0.01)。该效应在12月减弱(AOR = 0.45;P = 0.05)，并在5月前消失(AOR = 0.85;P = 0.67)。结论:在没有任何订单输入干预的情况下，单独自动eGFR报告仅与改善隐匿性肾功能不全老年人的剂量适宜性有短暂的相关性。

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引用次数: 11

Geriatric Pharmacotherapy Updates 老年药物治疗更新

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-10-01 DOI: 10.1016/j.amjopharm.2011.09.005

David R.P. Guay PharmD

引用次数: 0

Medication Reconciliation: Identifying Medication Discrepancies in Acutely Ill Hospitalized Older Adults 药物调解:识别急病住院老年人的药物差异

American Journal Geriatric Pharmacotherapy

Pub Date : 2011-10-01 DOI: 10.1016/j.amjopharm.2011.07.005

Diane Villanyi BSc Pharm, MD, FRCPC, Mark Fok BSc Pharm, MD, Roger Y.M. Wong BMSc, MD, FRCPC, FACP

Background

Medication discrepancies may occur during transitions from community to acute care hospitals. The elderly are at risk for such discrepancies due to multiple comorbidities and complex medication regimens. Medication reconciliation involves verifying medication use and identifying and rectifying discrepancies.

Objective

The aim of this study was to describe the prevalences and types of medication discrepancies in acutely ill older patients.

Methods

Patients who were ≥70 years and were admitted to any of 3 acute care for elders (ACE) units over a period of 2 nonconsecutive months in 2008 were prospectively enrolled. Medication discrepancies were classified as intentional, undocumented intentional, and unintentional. Unintentional medication discrepancies were classified by a blinded rater for potential to harm. This study was primarily qualitative, and descriptive (univariate) statistics are presented.

Results

Sixty-seven patients (42 women; mean [SD] age, 84.0 [6.5] years) were enrolled. There were 37 unintentional prescription-medication discrepancies in 27 patients (40.3%) and 43 unintentional over-the-counter (OTC) medication discrepancies in 19 patients (28.4%), which translates to Medication Reconciliation Success Index (MRSI) of 89% for prescription medications and 59% for OTC medications. The overall MRSI was 83%. More than half of the prescription-medication discrepancies (56.8%) were classified as potentially causing moderate/severe discomfort or clinical deterioration.

Conclusion

Despite a fairly high overall MRSI in these patients admitted to ACE units, a substantial proportion of the prescription-medication discrepancies were associated with potential harm.

背景:从社区医院到急症护理医院的过渡过程中可能出现用药差异。由于多种合并症和复杂的药物治疗方案，老年人面临这种差异的风险。药物对账包括验证药物使用，识别和纠正差异。目的探讨老年急性病患者用药差异的发生率和类型。方法前瞻性入选年龄≥70岁，在2008年非连续2个月内入住3个老年人急性护理(ACE)病房的患者。用药差异分为故意、未记录的故意和非故意。无意用药差异由盲法评分者根据潜在危害进行分类。本研究主要是定性的，并提出了描述性(单变量)统计。结果67例患者(女性42例;平均[SD]年龄，84.0[6.5]岁)。27例患者(40.3%)存在37项非故意处方用药差异，19例患者(28.4%)存在43项非故意非处方(OTC)用药差异，即处方药的药物和解成功指数(MRSI)为89%，非处方药物为59%。总体MRSI为83%。超过一半的处方用药差异(56.8%)被归类为可能导致中度/重度不适或临床恶化。结论:尽管在ACE住院的这些患者中有相当高的总体MRSI，但很大一部分处方用药差异与潜在危害有关。

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引用次数: 44