PDF(Pubmed)
Abstract：
UNASSIGNED: Potentially inappropriate medication (PIM) exposes patients to an increased risk of adverse outcomes. Many lists of explicit criteria provide guidance on identifying PIM and recommend alternative prescribing, but the complexity of available lists limits their applicability and the amount of data available on PIM prescribing.
UNASSIGNED: To determine PIM prevalence and the most frequently prescribed PIMs according to 6 well-known PIM lists and to develop a best practice synthesis for clinicians.
UNASSIGNED: This cross-sectional study used anonymized electronic health record data of Swiss primary care patients aged 65 years or older with drug prescriptions from January 1, 2020, to December 31, 2021, extracted from a large primary care database in Switzerland, the FIRE project. Data analyses took place from October 2022 to September 2023.
UNASSIGNED: PIM prescription according to PIM criteria operationalized for use with FIRE data.
UNASSIGNED: The primary outcomes were PIM prevalence (percentage of patients with 1 or more PIMs) and PIM frequency (percentage of prescriptions identified as PIMs) according to the individual PIM lists and a combination of all 6 lists. The PIM lists used were the American 2019 Updated Beers criteria, the French list by Laroche et al, the Norwegian General Practice Norwegian (NORGEP) criteria, the German PRISCUS list, the Austrian list by Mann et al, and the EU(7) consensus list of 7 European countries.
UNASSIGNED: This study included 115 867 patients 65 years or older (mean [SD] age, 76.0 [7.9] years; 55.8% female) with 1 211 227 prescriptions. Among all patients, 86 715 (74.8%) were aged 70 years or older, and 60 670 (52.4%) were aged 75 years or older. PIM prevalence among patients 65 years or older was 31.5% (according to Beers 2019), 15.4% (Laroche), 16.1% (NORGEP), 12.7% (PRISCUS), 31.2% (Mann), 37.1% (EU[7]), and 52.3% (combined list). PIM prevalence increased with age according to every PIM list (eg, according to Beers 2019, from 31.5% at age 65 years or older to 37.4% for those 75 years or older, and when the lists were combined, PIM prevalence increased from 52.3% to 56.7% in those 2 age groups, respectively). PIM frequency was 10.3% (Beers 2019), 3.9% (Laroche), 4.3% (NORGEP), 2.4% (PRISCUS), 6.7% (Mann), 9.7% (EU[7]), and 19.3% (combined list). According to the combined list, the 5 most frequently prescribed PIMs were pantoprazole (9.3% of all PIMs prescribed), ibuprofen (6.9%), diclofenac (6.3%), zolpidem (4.5%), and lorazepam (3.7%). Almost two-thirds (63.5%) of all PIM prescriptions belonged to 5 drug classes: analgesics (26.9% of all PIMs prescribed), proton pump inhibitors (12.1%), benzodiazepines and benzodiazepine-like drugs (11.2%), antidepressants (7.0%), and neuroleptics (6.3%).
UNASSIGNED: In this cross-sectional study of adults aged 65 or older, PIM prevalence was high, varied considerably depending on the criteria applied, and increased consistently with age. However, only few drug classes accounted for the majority of all prescriptions that were PIM according to any of the 6 PIM lists, and by considering this manageable number of drug classes, clinicians could essentially comply with all 6 PIM lists. These results raise awareness of the most common PIMs and emphasize the need for careful consideration of their risks and benefits and targeted deprescribing.
UNASSIGNED: To determine PIM prevalence and the most frequently prescribed PIMs according to 6 well-known PIM lists and to develop a best practice synthesis for clinicians.
UNASSIGNED: This cross-sectional study used anonymized electronic health record data of Swiss primary care patients aged 65 years or older with drug prescriptions from January 1, 2020, to December 31, 2021, extracted from a large primary care database in Switzerland, the FIRE project. Data analyses took place from October 2022 to September 2023.
UNASSIGNED: PIM prescription according to PIM criteria operationalized for use with FIRE data.
UNASSIGNED: The primary outcomes were PIM prevalence (percentage of patients with 1 or more PIMs) and PIM frequency (percentage of prescriptions identified as PIMs) according to the individual PIM lists and a combination of all 6 lists. The PIM lists used were the American 2019 Updated Beers criteria, the French list by Laroche et al, the Norwegian General Practice Norwegian (NORGEP) criteria, the German PRISCUS list, the Austrian list by Mann et al, and the EU(7) consensus list of 7 European countries.
UNASSIGNED: This study included 115 867 patients 65 years or older (mean [SD] age, 76.0 [7.9] years; 55.8% female) with 1 211 227 prescriptions. Among all patients, 86 715 (74.8%) were aged 70 years or older, and 60 670 (52.4%) were aged 75 years or older. PIM prevalence among patients 65 years or older was 31.5% (according to Beers 2019), 15.4% (Laroche), 16.1% (NORGEP), 12.7% (PRISCUS), 31.2% (Mann), 37.1% (EU[7]), and 52.3% (combined list). PIM prevalence increased with age according to every PIM list (eg, according to Beers 2019, from 31.5% at age 65 years or older to 37.4% for those 75 years or older, and when the lists were combined, PIM prevalence increased from 52.3% to 56.7% in those 2 age groups, respectively). PIM frequency was 10.3% (Beers 2019), 3.9% (Laroche), 4.3% (NORGEP), 2.4% (PRISCUS), 6.7% (Mann), 9.7% (EU[7]), and 19.3% (combined list). According to the combined list, the 5 most frequently prescribed PIMs were pantoprazole (9.3% of all PIMs prescribed), ibuprofen (6.9%), diclofenac (6.3%), zolpidem (4.5%), and lorazepam (3.7%). Almost two-thirds (63.5%) of all PIM prescriptions belonged to 5 drug classes: analgesics (26.9% of all PIMs prescribed), proton pump inhibitors (12.1%), benzodiazepines and benzodiazepine-like drugs (11.2%), antidepressants (7.0%), and neuroleptics (6.3%).
UNASSIGNED: In this cross-sectional study of adults aged 65 or older, PIM prevalence was high, varied considerably depending on the criteria applied, and increased consistently with age. However, only few drug classes accounted for the majority of all prescriptions that were PIM according to any of the 6 PIM lists, and by considering this manageable number of drug classes, clinicians could essentially comply with all 6 PIM lists. These results raise awareness of the most common PIMs and emphasize the need for careful consideration of their risks and benefits and targeted deprescribing.
摘要：
■潜在的不适当药物（PIM）会增加患者不良结局的风险。许多明确的标准列表为识别PIM提供了指导，并推荐了替代处方，但是可用列表的复杂性限制了它们的适用性和PIM处方的可用数据量。
■根据6个众所周知的PIM列表确定PIM患病率和最常用的处方PIM，并为临床医生制定最佳实践综合。
■这项横断面研究使用了从2020年1月1日至2021年12月31日的65岁或以上的瑞士初级保健患者的匿名电子健康记录数据，这些数据是从瑞士的大型初级保健数据库中提取的，火灾项目。数据分析从2022年10月到2023年9月进行。
■根据与FIRE数据一起使用的PIM标准执行的PIM处方。
■主要结果是PIM患病率（1个或更多PIM患者的百分比）和PIM频率（确定为PIM的处方百分比），根据单独的PIM列表和所有6个列表的组合。使用的PIM列表是美国2019年更新的啤酒标准，Laroche等人的法语名单，挪威普通实践挪威(NORGEP)标准，德国PRISCUS名单,Mann等人的奥地利名单，以及欧盟（7）7个欧洲国家的共识清单。
■这项研究包括115867名65岁或以上的患者（平均[SD]年龄，76.0[7.9]岁；55.8%为女性），处方1211227张。在所有患者中，86715(74.8%)年龄在70岁或以上，60670人(52.4%)年龄在75岁或以上。65岁或以上患者的PIM患病率为31.5%（根据Beers2019），15.4%(Laroche)，16.1%（NORGEP），12.7%（PRISCUS），31.2%(曼)，37.1%(欧盟[7])，和52.3%(合并名单)。根据每个PIM列表，PIM患病率随年龄增加(例如，根据Beers2019的数据，从65岁或以上的31.5%到75岁或以上的37.4%，当列表合并时，在这两个年龄组中，PIM患病率从52.3%上升到56.7%，分别)。PIM频率为10.3%（Beers2019），3.9%（Laroche），4.3%(NORGEP)，2.4%（PRISCUS），6.7%（曼），9.7%(欧盟[7])，和19.3%(合并名单)。根据合并名单,5个最常用的PIM是泮托拉唑（占所有PIM的9.3%），布洛芬(6.9%),双氯芬酸（6.3%），唑吡坦（4.5%），和劳拉西泮(3.7%)。几乎三分之二（63.5%）的所有PIM处方属于5类药物：镇痛药（26.9%的所有PIM处方），质子泵抑制剂（12.1%），苯二氮卓类药物和苯二氮卓类药物（11.2％），抗抑郁药（7.0%），和抗精神病药(6.3%)。
■在这项针对65岁或以上成年人的横断面研究中，PIM患病率高,根据所应用的标准，差异很大，并且随着年龄的增长而增加。然而,根据6个PIM列表中的任何一个，只有少数药物类别占所有PIM处方的大多数，考虑到这个可控的药物类别数量，临床医生基本上可以遵守所有6个PIM列表.这些结果提高了人们对最常见PIM的认识，并强调需要仔细考虑其风险和收益以及有针对性的处方。
■根据6个众所周知的PIM列表确定PIM患病率和最常用的处方PIM，并为临床医生制定最佳实践综合。
■这项横断面研究使用了从2020年1月1日至2021年12月31日的65岁或以上的瑞士初级保健患者的匿名电子健康记录数据，这些数据是从瑞士的大型初级保健数据库中提取的，火灾项目。数据分析从2022年10月到2023年9月进行。
■根据与FIRE数据一起使用的PIM标准执行的PIM处方。
■主要结果是PIM患病率（1个或更多PIM患者的百分比）和PIM频率（确定为PIM的处方百分比），根据单独的PIM列表和所有6个列表的组合。使用的PIM列表是美国2019年更新的啤酒标准，Laroche等人的法语名单，挪威普通实践挪威(NORGEP)标准，德国PRISCUS名单,Mann等人的奥地利名单，以及欧盟（7）7个欧洲国家的共识清单。
■这项研究包括115867名65岁或以上的患者（平均[SD]年龄，76.0[7.9]岁；55.8%为女性），处方1211227张。在所有患者中，86715(74.8%)年龄在70岁或以上，60670人(52.4%)年龄在75岁或以上。65岁或以上患者的PIM患病率为31.5%（根据Beers2019），15.4%(Laroche)，16.1%（NORGEP），12.7%（PRISCUS），31.2%(曼)，37.1%(欧盟[7])，和52.3%(合并名单)。根据每个PIM列表，PIM患病率随年龄增加(例如，根据Beers2019的数据，从65岁或以上的31.5%到75岁或以上的37.4%，当列表合并时，在这两个年龄组中，PIM患病率从52.3%上升到56.7%，分别)。PIM频率为10.3%（Beers2019），3.9%（Laroche），4.3%(NORGEP)，2.4%（PRISCUS），6.7%（曼），9.7%(欧盟[7])，和19.3%(合并名单)。根据合并名单,5个最常用的PIM是泮托拉唑（占所有PIM的9.3%），布洛芬(6.9%),双氯芬酸（6.3%），唑吡坦（4.5%），和劳拉西泮(3.7%)。几乎三分之二（63.5%）的所有PIM处方属于5类药物：镇痛药（26.9%的所有PIM处方），质子泵抑制剂（12.1%），苯二氮卓类药物和苯二氮卓类药物（11.2％），抗抑郁药（7.0%），和抗精神病药(6.3%)。
■在这项针对65岁或以上成年人的横断面研究中，PIM患病率高,根据所应用的标准，差异很大，并且随着年龄的增长而增加。然而,根据6个PIM列表中的任何一个，只有少数药物类别占所有PIM处方的大多数，考虑到这个可控的药物类别数量，临床医生基本上可以遵守所有6个PIM列表.这些结果提高了人们对最常见PIM的认识，并强调需要仔细考虑其风险和收益以及有针对性的处方。
