背景:多重药房经常被用作住宅老年人护理设施(RACF)中老年人的质量指标,并使用一系列定义进行测量。数据源选择对多药率的影响以及对监测和基准的影响尚不清楚。我们旨在通过在各种情况下使用处方和管理数据来确定多药率(≥9种并发药物),利用来自30个RACF的电子数据。
方法:对新南威尔士州5662名居民进行的纵向队列研究,澳大利亚。从2019年1月至2022年9月,每两周计算一次处方和管理的多药率,提供156次评估。使用处方和管理数据,并结合不同的项目组合,分别计算了12种不同的多药率:药物和非药物产品,四种情况下的任何药物和常规药物:不,1周,2周和4周回顾期。采用广义估计方程模型来确定处方和管理的多重用药之间差异的预测因素。
结果:居民的综合用药率从使用无回顾期的常规药物数据的33.9%到使用处方药和非药物产品的63.5%,为期4周的回顾期。在每个评估时间,处方和给药率之间的差异一直超过10.0%,4.5%,3.5%和3.0%,分别,没有,1周,2周和4周回顾期。与同行相比,糖尿病居民面临的多重用药差异的可能性是其两倍以上,而痴呆症居民在所有分析中始终显示出降低的可能性。
结论:我们发现处方和给药的多药率之间存在显著差异。我们建议对国家质量指标计划中计算和解释多种药物的指南进行审查,以确保一致的测量和有意义的报告。
BACKGROUND: Polypharmacy is frequently used as a quality indicator for older adults in Residential Aged Care Facilities (RACFs) and is measured using a range of definitions. The impact of data source choice on polypharmacy rates and the implications for monitoring and benchmarking remain unclear. We aimed to determine polypharmacy rates (≥9 concurrent medicines) by using prescribed and administered data under various scenarios, leveraging electronic data from 30 RACFs.
METHODS: A longitudinal cohort study of 5662 residents in New South Wales, Australia. Both prescribed and administered polypharmacy rates were calculated biweekly from January 2019 to September 2022, providing 156 assessment times. 12 different polypharmacy rates were computed separately using prescribing and administration data and incorporating different combinations of items: medicines and non-medicinal products, any medicines and regular medicines across four scenarios: no, 1-week, 2-week and 4-week look-back periods. Generalised estimating equation models were employed to identify predictors of discrepancies between prescribed and administered polypharmacy.
RESULTS: Polypharmacy rates among residents ranged from 33.9% using data on administered regular medicines with no look-back period to 63.5% using prescribed medicines and non-medicinal products with a 4-week look-back period. At each assessment time, the differences between prescribed and administered polypharmacy rates were consistently more than 10.0%, 4.5%, 3.5% and 3.0%, respectively, with no, 1-week, 2-week and 4-week look-back periods. Diabetic residents faced over two times the likelihood of polypharmacy discrepancies compared with counterparts, while dementia residents consistently showed reduced likelihood across all analyses.
CONCLUSIONS: We found notable discrepancies between polypharmacy rates for prescribed and administered medicines. We recommend a review of the guidance for calculating and interpreting polypharmacy for national quality indicator programmes to ensure consistent measurement and meaningful reporting.