潜在不适当用药和多重用药对老年患者3个月内再次入院的影响：一项来自马来西亚的回顾性队列研究。
The Impact of Potentially Inappropriate Medications and Polypharmacy on 3-Month Hospital Readmission among Older Patients: A Retrospective Cohort Study from Malaysia.
作者信息
Akkawi Muhammad Eid, Abd Aziz Hani Hazirah, Fata Nahas Abdul Rahman
机构信息
Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan 25150, Malaysia.
Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan 25150, Malaysia.
出版信息
Geriatrics (Basel). 2023 Apr 30;8(3):49. doi: 10.3390/geriatrics8030049.
INTRODUCTION
Potentially inappropriate medications (PIMs) use and polypharmacy are two issues that are commonly encountered among older people. They are associated with several negative outcomes including adverse drug reactions and medication-related hospitalization. There are insufficient studies regarding the impact of both PIMs and polypharmacy on hospital readmission, especially in Malaysia.
AIM
To investigate the possible association between polypharmacy and prescribing PIMs at discharge and 3-month hospital readmission among older patients.
MATERIALS AND METHOD
A retrospective cohort study involved 600 patients ≥60 years discharged from the general medical wards in a Malaysian teaching hospital. The patients were divided into two equal groups: patients with or without PIMs. The main outcome was any readmission during the 3-month follow-up. The discharged medications were assessed for polypharmacy (≥five medications) and PIMs (using 2019 Beers' criteria). Chi-square test, Mann-Whitney test, and a multiple logistic regression were conducted to study the impact of PIMs/polypharmacy on 3-month hospital readmission.
RESULTS
The median number for discharge medications were six and five for PIMs and non-PIMs patients, respectively. The most frequently prescribed PIMs was aspirin as primary prevention of cardiovascular diseases (33.43%) followed by tramadol (13.25%). The number of medications at discharge and polypharmacy status were significantly associated with PIMs use. Overall, 152 (25.3%) patients were re-admitted. Polypharmacy and PIMs at discharge did not significantly impact the hospital readmission. After applying the logistic regression, only male gender was a predictor for 3-month hospital readmission (OR: 2.07, 95% CI: 1.022-4.225).
CONCLUSION
About one-quarter of the patients were admitted again within three months of discharge. PIMs and polypharmacy were not significantly associated with 3-month hospital readmissions while male gender was found to be an independent risk factor for readmission.
引言
潜在不适当用药（PIMs）和多重用药是老年人中常见的两个问题。它们与多种负面结果相关，包括药物不良反应和与用药相关的住院治疗。关于PIMs和多重用药对再次入院的影响的研究不足，尤其是在马来西亚。
目的
调查老年患者出院时多重用药和开具PIMs与3个月内再次入院之间的可能关联。
材料与方法
一项回顾性队列研究纳入了马来西亚一家教学医院普通内科病房出院的600名60岁及以上患者。患者被分为两组，每组人数相等：使用PIMs的患者和未使用PIMs的患者。主要结局是3个月随访期间的任何再次入院情况。对出院用药进行多重用药（≥5种药物）和PIMs（使用2019年Beers标准）评估。进行卡方检验、曼-惠特尼检验和多元逻辑回归分析，以研究PIMs/多重用药对3个月再次入院的影响。
结果
PIMs组和非PIMs组患者出院用药的中位数分别为6种和5种。最常开具的PIMs是作为心血管疾病一级预防的阿司匹林（33.43%），其次是曲马多（13.25%）。出院时的用药数量和多重用药状态与PIMs的使用显著相关。总体而言，152名（25.3%）患者再次入院。出院时的多重用药和PIMs对再次入院没有显著影响。应用逻辑回归分析后，只有男性是3个月再次入院的预测因素（OR：2.07，95%CI：1.022 - 4.225）。
结论
约四分之一的患者在出院后三个月内再次入院。PIMs和多重用药与3个月再次入院没有显著关联，而男性被发现是再次入院的独立危险因素。
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