背景:几十年来,美国的药物利用率逐年增加。随着老年人服用更多的药物,他们暴露于药物-药物或药物-疾病相互作用的风险较高。美国老年医学会在2019年更新了他们在老年人中使用潜在不适当药物(PIM)的啤酒标准。这项研究的目的是评估2019Beers标准中包含的药物利用率。
方法:使用2020日历年的MedicareD部分提供者利用率和支付数据公共使用文件进行了分析。2019年啤酒标准中确定的药物被应用于分析。评估了两类药物:(1)“避免”和(2)“谨慎使用”。
结果:2020年,向65岁及以上的Medicare患者分发了5600万张处方,建议毫无例外地避免使用(占所有处方的4.7%),总计9.57亿美元的药物费用。此类中使用最多的药物类别是苯二氮卓类药物(25,949,994处方),“Z药”(6,204,909处方),长效磺脲类药物(5,306,577处方),第一代抗组胺药(5,049,289处方),和三环抗抑郁药(4,190,062处方)。此外,向65岁及65岁以上的Medicare受益人分发了1.35亿张处方,其中Beers标准指出要谨慎使用(占所有处方的11.3%)超过28.5亿美元的药物费用。这一类最常用的药物是利尿剂(74,599,126处方),选择性5-羟色胺再摄取抑制剂(30,033,121处方),5-羟色胺和去甲肾上腺素再摄取抑制剂(11,858,968处方),曲马多(11,450,878处方),和米氮平(5,737,304处方)。
结论:即使存在AGS啤酒在老年人中使用PIM标准及其持续更新的版本,分配给MedicareD部分的药物中有16%可能不合适。需要未来的研究来评估这是否导致使用这些PIM的老年人的预后恶化。
BACKGROUND: Medication utilization has been increasing in the U.S. year-over-year for several decades. As older adults take more medications, there is a higher risk of them being exposed to drug-drug or drug-disease interactions. The American Geriatrics Society in 2019 updated their Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults. The objective of this study was to assess the prevalence of utilization of medications included in the 2019 Beers Criteria.
METHODS: An analysis was conducted using the Medicare Part D Provider Utilization and Payment Data Public Use File for calendar-year 2020. Medications identified in the 2019 Beers Criteria were applied to the analysis. Two categories of medications were assessed: (1) \"Avoid\" and (2) \"Use With Caution.\"
RESULTS: In 2020, 56 million prescriptions were dispensed to Medicare patients 65 years and older that are recommended to be avoided without exception (4.7% of all prescriptions) totaling $957 million in medication costs. The most utilized medication classes in this category were benzodiazepines (25,949,994 prescriptions), \"Z-drugs\" (6,204,909 prescriptions), long-acting sulfonylureas (5,306,577 prescriptions), 1st-generation antihistamines (5,049,289 prescriptions), and tricyclic antidepressants (4,190,062 prescriptions). Additionally, 135 million prescriptions were dispensed to Medicare beneficiaries 65 years and older for medications which the Beers Criteria states to use caution (11.3% of all prescriptions) exceeding $2.85 billion in medication costs. The most utilized medications for this category were diuretics (74,599,126 prescriptions), selective serotonin reuptake inhibitors (30,033,121 prescriptions), serotonin and norepinephrine reuptake inhibitors (11,858,968 prescriptions), tramadol (11,450,878 prescriptions), and mirtazapine (5,737,304 prescriptions).
CONCLUSIONS: Even with the existence of the AGS Beers Criteria for PIM Use in Older Adults and its continued updated versions, 16% of medications dispensed to Medicare Part D were potentially inappropriate. Future studies are needed to assess if this has led to worsened outcomes among older adults who utilized these PIM.