本院老年门诊患者潜在不适当用药评估分析  

Evaluation of potentially inappropriate medication in elderly outpatients in our hospital

作　　者：施念玮[1] 吴亦影[1] 倪秀石[1] 

机构地区：[1]上海交通大学附属第一人民医院老年科,上海200080

出　　处：《中国新药与临床杂志》2015年第9期666-670,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的分析老年门诊患者潜在不适当用药(PIMs)的临床特征及危险因素。方法采用横断面调查的方法,收集本院老年科门诊年龄≥60岁患者的人口学、临床诊断、用药情况、药物不良反应(ADRs)、认知功能、用药依从性等资料,以Beers标准对PIMs进行评估分析。比较有和无PIMs患者的各项资料差异,logistic回归分析法分析PIMs与危险因素的相关性。结果共纳入1 187例患者,年龄(79.8±7.3)岁,PIMs发生率为25.02%(297/1187)。PIMs组患者年龄[(82.8±7.4)岁vs.(78.6±7.1)岁]、共患病种数(4.2±1.0 vs.3.2±1.0)、用药种数(11.0±2.6 vs.7.9±2.3)、认知功能损害比例(42.1%vs.12.1%)及ADRs发生率(30.3%vs.6.6%)均高于无PIMs组(P<0.05或P<0.01),而用药依从性良好比例低于无PIMs组(86.2%vs.95.2%,P<0.05)。Logistic分析显示年龄>70岁、共患病≥2种、用药种数≥10种、认知功能损害与PIMs呈显著正相关(P<0.01),良好的用药依从性与PIMs呈显著的负相关(P<0.01)。结论老年门诊患者发生PIMs的比例较高,PIMs患者出现ADRs的风险也大。除高龄、共患病种数、用药种数等因素外,认知功能损害也是PIMs的独立危险因素,而良好的用药依从性可减少老年门诊患者发生PIMs的风险。AIM To evaluate the prevalence and risk factors of potentially inappropriate medications （HMs） among elderly outpatients. METHODS The demographic data, clinical diagnosis and medications, adverse drug reactions （ADRs） , cognitive disorders and medication compliance of outpatients aged over 60 years were retrieved using cross-sectional survey and PIMs were evaluated by Beers＇ criteria 2012. The each index of patients with PIMs was compared with that of patients without PIMs. The relation between PIMs and risk factors were analyzed by logistic regression. RESULTS There were 1 187 patients enrolled, and 25.02% （297/ 1 187） of patients were prescribed for one PIMs at least. Patients with PIMs were significantly older than those without PIMs （82.8 ± 7.4 vs. 78.6 ± 7.1, P 〈 0.01） . And they had more comorbidities （4.2 ± 1.0 vs. 3.2 ± 1.0, P 〈 0.05）, more medications （11.0 ± 2.6 vs. 7.9 ± 2.3, P 〈 0.05）, more cognitive disorders （42.1% vs. 12.1%, P 〈 0.05）, more ADRs （30.3% vs. 6.6%, P 〈 0.01） but less medication compliance （86.2% vs. 95.2%, P 〈 0.05） than those without PIMs. Multiple logistic regression showed that 〉 70 years old age, I〉 2 of comorbidities, ≥ 10 of drugs prescribed, and cognitive disorders were positively related with PIMs （P 〈 0.01） . By contrast, good medication compliance was negatively related with PIMs （P 〈 0.01） . CONCLUSION The rate of PIMs among elderly outpatients is higher. Patients with PIMs have a high risk of ADRs. In addition to old age, the number of comorbidities and prescribed medications, cognitive disorders is an independent risk factor of PIMs. Good medication compliance could markedly reduce the risk of PIMs in elderly outpatients.

关 键 词：老年人 服药依从性 认知障碍 潜在不适当用药 Beers标准 

分 类 号：R98[医药卫生—药品]