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JAMDA:养老院里不当精神类药物处方太多居然是因为医生太多?

2015-07-11 MedSci MedSci原创

目的:该实验的目的是探究养老院全科医生的数目是否会影响医生开具不适当的精神类药品处方。方式:该实验为横断面研究。研究地点在法国175家养老院进行。参与人员为2011年5月到7月入住的6275名居民。我们关注的主要指标:是依据法国的处方指导和改进指南,发现是否有不当的精神病药物处方。养老院的医生通过电子设备记录居民特征和养老院的设施特征。由于数据的层次结构(居民居住水平和养老院护理的水平),我们采用

目的:
该实验的目的是探究养老院全科医生的数目是否会影响医生开具不适当的精神类药品处方。


方式:
该实验为横断面研究。研究地点在法国175家养老院进行。参与人员为2011年5月到7月入住的6275名居民。我们关注的主要指标:是依据法国的处方指导和改进指南,发现是否有不当的精神病药物处方。养老院的医生通过电子设备记录居民特征和养老院的设施特征。由于数据的层次结构(居民居住水平和养老院护理的水平),我们采用多因素逻辑回归分析,以探究导致医生开不恰当精神类药物处方的相关因素。

结果:
在记录的6275名居民中,1532位居民(占24.4%)至少有一个精神病药物处方。这相当于有513居民(占33.5%)有适当的精神类药物处方(药物的种类和剂量合适)和1019名(占66.5%)居民具有潜在的不恰当处方的危险。逻辑回归模型显示,全科医生的数目与不恰当处方的数目有关,若养老院全科医生的数目达到或超过30位/100张床,则开具不恰当处方的风险要高于全科医生的数目不超过10位/100张床的养老院(调整后的优势比为1.80,95%可信区间为1.04-3.12);且养老院中年龄超过85岁并患有老年痴呆的老人更有可能有不恰当的处方(调整后的优势比为1.75,95%可信区间为1.32-2.32;调整后的优势比为2.06,95%可信区间为1.56-2.74);而那些说自己没有精神类药物处方的居民往往有类似处方(调整后的优势比为1.96,95%可信区间为1.03-3.74)。

结论:
该研究表明,养老院居民的精神类药物处方过多,可能是由于医生太多了。

原始出处:

Laffon de Mazières C, Lapeyre-Mestre M, Vellas B, de Souto Barreto P, Rolland Y.Organizational Factors Associated With Inappropriate Neuroleptic Drug Prescribing in Nursing Homes: A Multilevel Approach. J Am Med Dir Assoc. 2015 Jul 1;16(7):590-7.

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    2017-05-24 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

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    2016-06-13 wetgdt
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    2015-07-13 zhty5337
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    2015-07-13 tulenzi
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