基于北京市医保数据分析门诊潜在不适当用药现状及对骨折、跌倒和低血糖而住院或急诊的发生率的影响

Prevalence of potentially inappropriate medication in outpatients based on Beijing medical insurance data and its effects on the incidences of hospitalization and emergency department visits due to fracture,fall and hypoglycemia

目的:调查门诊患者潜在不适当用药(PIM)发生率,并探究PIM与因骨折、跌倒和低血糖住院和急诊就诊发生率的关系。方法:回顾性分析北京市医保数据库2016年7~9月数据。纳入的患者年龄均≥65岁,应用Beers 2015版识别PIM。暴露PIM的定义为服用PIM≥14 d。通过住院和急诊的诊断判定骨折、跌倒和低血糖的临床结局。结果:研究共纳入506214位患者,PIM发生率为38.07%,其中19.69%服用了1种PIM,9.04%服用2种PIM,9.35%服用了≥3种PIM。被处方最多的PIM依次为血管扩张剂、短或中效苯二氮[艹卓]类药物、非甾体抗炎药、利尿剂和外周α-1阻滞剂。PIM主要由三级医院开具(52.17%)。随着服用PIM数量的增加,骨折急诊发生率增加(P<0.05)、低血糖急诊发生率增加(P<0.05)。然而使用PIM后因骨折、跌倒和低血糖住院的发生率以及跌倒急诊就诊的发生率并未随服用PIM数量的增加而增加(P>0.05)。结论:随着患者服用PIM数量的增加,骨折急诊和低血糖急诊发生率增加。本研究的结论为医疗政策制定者、实施者、研究者全面且合理地评估老年人多重用药提供了的参考依据。

OBJECTIVE To investigate the prevalence of potentially inappropriate medication(PIM)in outpatients and to explore the relationship between PIM and the incidences of hospitalization and emergency department(ED)visits due to fractures,falls and hypoglycemia.METHODS A retrospective cohort study based on the data from Beijing’s Longitudinal Health Insurance database was performed.The study included community-dwelling sample of adults aged 65 and older during July and September 2016.The prevalence of PIM was estimated based on the 2015 Beers Criteria;.PIM exposure was defined as with PIM for more than 14 days.The clinical outcomes of fracture,fall and hypoglycemia-specific hospitalization and ED visits were determined by the diagnosis in the inpatients and ED visits data files.RESULTS Totally 506214 patients were included with a median age of 74 years(ranged from65 to 105 years),and 50.10%of them were women.The prevalence of PIM was38.07%.Of patients with PIM,19.69%were with one PIM,9.04%with two PIMs and 9.35%with more than three PIMs.The most frequently prescribed PIMs were vasodilators,short or medium acting benzodiazepines,non-steroidal anti-inflammatory drugs(NSAIDs),diuretics and peripheralα-1 blockers.PIM is mainly prescribed from tertiary hospitals(52.17%).With the increased number of PIM,the incidence of fracture-specific ED visits(P<0.05)and hypoglycemia-specific ED visits were increasing(P<0.05).However,the incidence of fracture-specific,fall-specific and hypoglycemia-specific hospitalizations and fall-specific ED visits did not increase with the increased number of PIM(P>0.05).CONCLUSION The incidences of fractures and hypoglycemia-specific ED visits increase with the increasing number of PIM exposure.The results provide a way for medical policy makers,implementers and researchers to evaluate the appropriateness of polypharmacy in the elderly comprehensively.