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Potenziell inadäquate Medikation in einem deutschen Praxisnetz – Wer verordnet was an wen?

Potentially inappropriate medication in a German practice network—who prescribes what to whom?

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Zusammenfassung

Hintergrund

Potenziell inadäquate Medikation (PIM) birgt für ältere Menschen das Risiko erhöhter Arzneimittelnebenwirkungen. Daten zur Prävalenz sind bekannt, jedoch gibt es bisher keine beschreibende Analyse der Verordnungen, die einen Ansatzpunkt zur Reduktion von PIM liefert.

Ziel der Arbeit

Ziel der Untersuchung ist es, die Verordnungen von PIM im ambulanten Sektor zu analysieren und Risikogruppen zu identifizieren, in denen eine verstärkte Sensibilisierung für das Thema notwendig ist.

Material und Methoden

Untersuchungsgrundlage ist ein Datensatz der AOK Bayern, der anonymisierte Verordnungsdaten eines Praxisnetzes an Patienten ab 65 Jahren von 2010 bis 2014 beinhaltet. Zur Identifikation der PIM wird die Priscus-Liste verwendet.

Ergebnisse

Für den Untersuchungszeitraum liegen 410.934 Verordnungen vor. Die Prävalenz von PIM-Verordnungen lag bei 5,60 %. Hausärzte verordneten 5,39 % PIM; Fachärzte für Neurologie/Psychiatrie/Psychotherapie (NPP) verordneten 16,36 % PIM. Arztgruppenübergreifend wurden am häufigsten PIM aus den Arzneimittelgruppen der Psycholeptika, Psychoanaleptika oder Antihypertonika verordnet. Bei Männern und Frauen entfielen in dem Zeitraum 4,50 % bzw. 6,31 % der Verordnungen auf PIM. Hinsichtlich der Altersgruppen erhielten hochbetagte Frauen am häufigsten PIM.

Diskussion

Bei Fachärzten für NPP ist zwar eine hohe Verordnungsprävalenz von PIM festzustellen, jedoch verordnen Hausärzte, absolut gesehen, insgesamt deutlich mehr PIM. Davon sind v. a. Frauen, v. a. zwischen 80 und 84 Jahren, betroffen. Zukünftig sollten Hausärzte stärker sensibilisiert werden, was ihre Verordnungen an ältere Frauen im Bereich Psychopharmaka und Antihypertonika betrifft.

Abstract

Background

Potentially inappropriate medication (PIM) carries the risk of increased drug side effects for older people. The prevalence data are known but no descriptive analyses of prescription behavior as a starting point for reducing PIM have yet been conducted.

Objective

The aim of the study was to analyze PIM prescription in the outpatient sector and to identify risk groups where increased awareness of the issue is needed.

Material and methods

The basis for the investigation was the data set of the AOK Bavaria health insurance, which contains anonymized prescription data of a practice network for patients aged 65 years and older from 2010 to 2014. The Priscus list was used to identify the PIM.

Results

There were 410,934 prescriptions during the investigation period. The prevalence of PIM was 5.60%. Family doctors prescribed 5.39% PIM and specialists for neurology, psychiatry and psychotherapy (NPP) prescribed 16.36% PIM. Regardless of the medical discipline, PIM from the drug groups psycholeptics, psychoanaleptics and antihypertensive drugs were most frequently prescribed. For men and women PIM accounted for 4.50% and 6.31%, respectively, of the prescriptions during the period. In terms of age groups older women received PIM most frequently.

Conclusion

In the case of specialists for NPP a high prevalence of prescriptions for PIM could be established; however, in absolute terms family doctors prescribed significantly more PIM overall. This mainly affected women and especially those between 80 and 84 years old. In the future family doctors should be made more aware with respect to the prescription of psychopharmaceuticals and antihypertensive drugs to older women.

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Authors and Affiliations

  1. Lehrstuhl für Gesundheitsmanagement, Institut für Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nürnberg, Deutschland

    Katharina Gudd &  Oliver Schöffski MPH

  2. Wilhelm Löhe Hochschule, Fürth, Deutschland

    Florian Meier

  3. Qualität und Effizienz eG, Nürnberg, Deutschland

    Jörg Lindenthal MBA &  Veit Wambach

Authors
  1. Katharina Gudd
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  2. Florian Meier
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  3. Jörg Lindenthal MBA
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  4. Veit Wambach
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  5. Oliver Schöffski MPH
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Correspondence to Katharina Gudd.

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Interessenkonflikt

K. Gudd, F. Meier, J. Lindenthal, V. Wambach und O. Schöffski geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Gudd, K., Meier, F., Lindenthal, J. et al. Potenziell inadäquate Medikation in einem deutschen Praxisnetz – Wer verordnet was an wen?. Z Gerontol Geriat 53, 647–654 (2020). https://doi.org/10.1007/s00391-019-01660-x

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