Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study.

IF 1.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Sao Paulo Medical Journal Pub Date : 2023-07-31 eCollection Date: 2023-01-01 DOI:10.1590/1516-3180.2022.0666.R1.190523

Karina Sichieri, Danilo Donizetti Trevisan, Ricardo Luís Barbosa, Silvia Regina Secoli

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引用次数: 0

Abstract

Background: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use.

Objective: To estimate the incidence and factors associated with PIMs use in intensive care units.

Design and setting: Historical cohort study was conducted in a high-complexity hospital in Brazil.

Methods: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%.

Results: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43).

Conclusions: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

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重症监护中老年人潜在的不适当药物及其相关因素：一项历史性队列研究。

背景：重症监护室中潜在不适当药物（PIM）的流行病学仍然有限，尤其是在与使用相关的因素方面。目的：评估重症监护室使用PIM的发生率和相关因素。设计和设置：在巴西一家高复杂性医院进行历史队列研究。方法：对314名年龄≥60岁的患者进行回顾性图表回顾，这些患者在巴西一所高复杂性医院的重症监护室（ICU）接受治疗。这些日期是从“患者安全项目”数据库中提取的。采用卡方检验、Student t检验和多变量逻辑回归分析来评估哪些因素与PIM相关。统计显著性设定为5%。结果：根据Beers的标准，12.8%的已鉴定药物被认为不适合老年人群。PIM的使用发生率为45.8%。最常用的PIM是甲氧氯普胺、胰岛素、抗精神病药物、非甾体抗炎药和苯二氮卓类药物。与PIM使用相关的因素是药物的数量（比值比[OR]=1.17）、住院时间（OR=1.07）和过度的潜在药物相互作用（OR=2.43）。结论：ICU中大约一半的老年人接受了PIM。服用PIM的患者在重症监护室的停留时间更长，药物用量更大，潜在药物相互作用的次数也更高。在重症监护室，使用明确的方法结合临床判断有助于提高药物处方的安全性和质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sao Paulo Medical Journal 医学-医学：内科

CiteScore

2.20

自引率

7.10%

发文量

210

审稿时长

6-12 weeks

期刊介绍： Published bimonthly by the Associação Paulista de Medicina, the journal accepts articles in the fields of clinical health science (internal medicine, gynecology and obstetrics, mental health, surgery, pediatrics and public health). Articles will be accepted in the form of original articles (clinical trials, cohort, case-control, prevalence, incidence, accuracy and cost-effectiveness studies and systematic reviews with or without meta-analysis), narrative reviews of the literature, case reports, short communications and letters to the editor. Papers with a commercial objective will not be accepted.