Suboptimal prescribing in elderly outpatients: potentially harmful drug-drug and drug-disease combinations.
| Autor: | Zhan C; Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Maryland 20850, USA. czhan@ahrq.gov |
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| Jazyk: | angličtina |
| Zdroj: | Journal of the American Geriatrics Society [J Am Geriatr Soc] 2005 Feb; Vol. 53 (2), pp. 262-7. |
| DOI: | 10.1111/j.1532-5415.2005.53112.x |
| Abstrakt: | Objectives: To assess the prevalence and correlates of potentially harmful drug-drug combinations and drug-disease combinations prescribed for elderly patients at outpatient settings. Design: Retrospective analysis of the 1995-2000 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). Setting: Physician offices and hospital outpatient departments. Participants: Outpatient visits by patients aged 65 and older in the NAMCS and NHAMCS (n=70,203). Measurements: Incidences of six drug-drug combinations and 50 drug-disease combinations that can place elderly patients at risk for adverse events according to expert consensus panels. Results: Overall, 0.74% (95% confidence interval (CI)=0.65-0.83) of visits with two or more prescriptions had at least one inappropriate drug-drug combination, and 2.58% (95% CI=2.44-2.72) of visits with at least one prescription had one or more inappropriate drug-disease combinations. Of visits with a prescription of warfarin, 6.60% (95% CI=5.46-7.74) were prescribed a drug with potentially harmful interaction. Of patients with benign prostatic hypertrophy, 4.06% (95% CI=3.06-5.06) had at least one of six drugs that should be avoided. The number of drugs prescribed is most predictive of inappropriate drug-drug and drug-disease combinations. Conclusion: Potentially harmful drug-drug and drug-disease combinations occur in various degrees in outpatient care in the elderly population. Targeting combinations such as those involving warfarin that are high in prevalence and potential harm offers a practical approach to improving prescribing and patient safety. |
| Databáze: | MEDLINE |
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