| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 101 === Objective: Because older people are vulnerable to numerous diseases, they are often prescribed multiple medications, and are consequently at high risk for adverse reactions to medication. The issue of inappropriately prescribing medications for older adults has drawn attention globally. The purpose of this study is to investigate the prevalence of potentially inappropriately prescribing medication for older patients and its related factors. We hope that this study will be used as a reference regarding the safety of prescribing medications for elderly patients.
Method: This study obtained data from the sampled registry of beneficiaries containing millions of files in the National Health Insurance Research Database (NHIRD) from the National Health Research Institutes of Taiwan in 2005. Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (2003 version) were used as the standard for determining the potential inappropriate drug prescriptions for elderly adults. The prescriptions used by the outpatient, emergency, and admissions departments in 2009 for adults aged 65 or above were analyzed for factors that influence the misuse of medication: prescription characteristics, patient characteristics, and physician characteristics.
Beer’s Criteria Part1 Results:Of the 2,212,591outpatient prescriptions analyzed (for 104,045 elderly patients), 372,061 (16.82%) potentially inappropriate prescriptions were found; 66,766elderly patients (64.17%) had received at least one inappropriate prescription. Of the 52,027prescriptions (for27,988 elderly patients) provided during emergencies, 16,335 prescriptions (31.40%) were potentially inappropriate. A total of 11,559 aging patients (41.30%) had received at least one potentially inappropriate prescription. Based on the 43,830 prescriptions (for23,101 older adults) obtained from the admissions data, 21,689 were potentially inappropriate prescriptions (50.51%). A total of 14,126 elderly patients (61.15%) had received at least one potentially inappropriate prescription.
The related factors for inappropriately prescribing medication to elderly patients in the outpatient department were as follows: number of prescription drugs, physician seniority, and physician specialty. The factors in the emergency department were as follows: average unit price of prescription medication, chronic continuous prescription, patient residential area, disease severity (Charlson comorbidity index, CCI), hospital level. For the admissions department the factors were as follows: average unit price of prescription medication, patient sex, patient age, patient residential area, total number of visitations, disease severity (Charlson comorbidity index, CCI), hospital level. For the admissions department the factors were as follows: number of prescription drugs, patient sex, patient age, patient residential area, total number of admissions, disease severity (CCI), and physician specialty.
Beer’s Criteria Part2 Results:Of the 1,235,306outpatient prescriptions analyzed (for 61,970 elderly patients), 15,612 (1.26%) potentially inappropriate prescriptions were found; 7,689 elderly patients (12.41%) had received at least one inappropriate prescription. Of the 25,778 prescriptions (for 20,967 elderly patients) provided during emergencies, 84 prescriptions (0.33%) were potentially inappropriate. A total of 81 aging patients (0.39%) had received at least one potentially inappropriate prescription. Based on the 22,504 prescriptions (for17,493 older adults) obtained from the admissions data, 1,688 were potentially inappropriate prescriptions (7.50%). A total of 1,649 elderly patients (9.43%) had received at least one potentially inappropriate prescription. The related factors for inappropriately prescribing medication to elderly patients in the outpatient department were as follows: patient sex, patient residential area, total number of visitations, inappropriately prescribing risk, physician total elderly patient,
For the admissions department the factors were as follows: number of prescription drugs, patient sex, patient age, patient residential area, total number of admissions, disease severity (CCI), hospital level, and physician years, physician specialty.
The related factors for inappropriately prescribing medication to elderly patients in the outpatient department were as follows: number of prescription drugs, physician seniority, and physician specialty. The factors in the emergency department were as follows: average unit price of prescription medication, chronic continuous prescription, patient residential area, disease severity (Charlson comorbidity index, CCI), hospital level. For the admissions department the factors were as follows: average unit price of prescription medication, patient sex, patient age, patient residential area, total number of visitations, disease severity (Charlson comorbidity index, CCI), hospital level. For the admissions department the factors were as follows: number of prescription drugs, patient sex, patient age, patient residential area, total number of admissions, disease severity (CCI), and physician specialty.
Conclusion: In Taiwan, the prevalence of the potential inappropriate use of prescription drugs by elderly patients is higher than abroad. The inappropriate use of prescription drugs affects the drug safety of elderly patients. Relevant governmental units and medical care providers should implement measures to address the factors relating to the inappropriate use of prescription drugs, which would help improve the overall medical quality in Taiwan.
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