背景:老年人的多药疗法正在稳步增加,许多药物的组合可能会导致不良反应,特别是如果药物在药效学上相互作用。例子是增加跌倒风险的累加或协同作用,出血,5-羟色胺综合征和尖端扭转。已开发临床决策支持系统JanusmedRiskProfile,以根据患者用药清单发现此类风险。
目的:这项以注册为基础的回顾性研究的主要目的是研究老年患者(65岁或以上)在多重用药(定义为使用5种或5种以上药物)中的药效学风险。第二,我们研究了在斯德哥尔摩地区的主要电子健康记录系统中引入Janusmed风险简介是否影响了患者处方组合的比例,这些组合增加了所定义的九种不良反应类别的风险(抗胆碱能作用,出血,便秘,正交统计,QT延长,肾毒性,镇静,癫痫发作和5-羟色胺综合征)。
方法:所有65岁或以上的处方药数据,在JanusmedRiskProfile中检索并分析了至少5种合并用药的风险类别.比较了在引入之前(第1期)和之后(第2期)的4个月期间具有高/中度风险的患者比例。
结果:第1期(2016年11月至2017年2月)共127,719名患者,第2期(2017年11月至2018年2月)的131,458例患者被纳入研究.9种特性(抗胆碱能作用,出血,便秘,正交统计,QT延长,肾毒性,镇静,癫痫发作和5-羟色胺能作用)分别为10.9、34.7、32.8、33.6、17.2、0.7、15.4、0.5和2.4%,分别,在第1期和第2期的10.4、35.5、32.8、33.3、10.8、0.71、14.9、0.5和2.3%。镇静和QT延长的变化有统计学意义,最明显的QT延长从17.2降至10.8%(p<0.001)。在分析高风险患者时,出血的减少显着,正交统计,QT延长和镇静。
结论:老年人接触药物组合会增加潜在严重不良反应的风险。处方者似乎对QT延长的警告尤其有反应,在电子健康记录系统中实施的Janusmed风险简介中呈现。
Polypharmacy in older people is steadily increasing and a combination of many medicines may result in adverse effects, especially if the medicines interact pharmacodynamically. Examples are additive or synergistic effects increasing the risk of falls, haemorrhage, serotonin syndrome and torsade de pointes. The clinical decision support system Janusmed Risk Profile has been developed to find such risks based on a patients\' medication list.
The main aim of this retrospective register-based
study was to
study what pharmacodynamic risks older patients (aged 65 years or older) on polypharmacy (defined as using five or more medicines) are exposed to. Second, we studied if the introduction of the Janusmed Risk Profile in the main electronic health record system in Region Stockholm influenced the proportion of patients prescribed combinations that increase the risk for the nine adverse-effect categories defined (anticholinergic effects, haemorrhage, constipation, orthostatism, QT prolongation, renal toxicity, sedation, seizures and serotonin syndrome).
Data on all prescription medicines to individuals aged 65 years or older, and with at least five concomitant medicines were retrieved and analysed for the risk categories in the Janusmed Risk Profile. The proportions of patients with a high/moderate risk during a 4-month period before (period 1) and after (period 2) the introduction were compared.
A total of 127,719 patients in period 1 (November 2016-February 2017), and 131,458 patients in period 2 (November 2017-February 2018) were included in the
study. The proportion of patients with a high or moderate risk for each of the nine properties (anticholinergic effects, haemorrhage, constipation, orthostatism, QT prolongation, renal toxicity, sedation, seizures and serotonergic effects) were 10.9, 34.7, 32.8, 33.6, 17.2, 0.7, 15.4, 0.5 and 2.4%, respectively, in period 1 and 10.4, 35.5, 32.8, 33.3, 10.8, 0.71, 14.9, 0.5 and 2.3% in period 2. The changes for sedation and QT prolongation were statistically significant, with the most pronounced decrease for QT prolongation from 17.2 to 10.8% (p < 0.001). When analysing patients at a high risk, the decrease was significant for haemorrhage, orthostatism, QT prolongation and sedation.
Older people are exposed to combinations of medications that increase the risk for potentially severe adverse effects. Prescribers seem to respond especially to warnings for QT prolongation, presented in the Janusmed Risk Profile implemented in the electronic health record system.