OBJECTIVE: To produce a Polypharmacy Assessment Score to identify a population with unusual levels of prescribing who may be at risk of potentially problematic polypharmacy.
METHODS: Analyses will be performed in three parts: 1. A prediction model will be constructed using observed medications count as the dependent variable, with age, gender and long-term conditions as independent variables. A \'Polypharmacy Assessment Score\' will then be constructed through calculating the differences between the observed and expected count of prescribed medications, thereby highlighting people that have unexpected levels of prescribing. Parts 2 and 3 will examine different aspects of validity of the Polypharmacy Assessment Score: 2. To assess \'construct validity\', cross-sectional analyses will evaluate high-risk prescribing within populations defined by a range of Polypharmacy Assessment Scores, using both explicit (STOPP/START criteria) and implicit (Medication Appropriateness Index) measures of inappropriate prescribing. 3. To assess \'predictive validity\', a retrospective cohort study will explore differences in clinical outcomes (adverse drug reactions, unplanned hospitalisation and all-cause mortality) between differing scores.
CONCLUSIONS: Developing a cross-cutting measure of polypharmacy may allow healthcare professionals to prioritise and risk stratify patients with polypharmacy using unusual levels of prescribing. This would be an improvement from current approaches of either using simple cutoffs or narrow prescribing criteria.
目的:产生多重用药评估评分,以确定处方水平异常的人群,他们可能面临潜在问题多重用药的风险。
方法:分析将分三个部分进行:1。将使用观察到的药物计数作为因变量来构建预测模型,随着年龄,性别和长期条件为自变量。然后将通过计算观察到的和预期的处方药物计数之间的差异来构建“多药房评估评分”。从而突出了处方水平出乎意料的人。第2部分和第3部分将检查多重药学评估得分的有效性的不同方面:2。要评估“构造有效性”,横断面分析将评估由一系列多药房评估分数定义的人群中的高风险处方,使用显式(STOPP/START标准)和隐式(药物适当性指数)测量不适当的处方。3.要评估“预测有效性”,一项回顾性队列研究将探讨临床结局的差异(药物不良反应,计划外住院和全因死亡率)在不同评分之间。
结论:制定多重用药的交叉措施可能会使医疗保健专业人员使用不寻常的处方水平对多重用药患者进行优先排序和风险分层。这将是对使用简单截止或狭窄处方标准的当前方法的改进。