中国14省27家医院住院老年慢病患者多重用药现状横断面研究  

A Cross-sectional Study on the Status of Polypharmacy among Older Chinese Inpatients with Chronic Diseases in 27 Hospitals from 14 Provinces

作　　者：王可[1,2] 唐静 杨昆[3] 姜德春 苏甦 邢晓璇[1,2] 闫素英 Wang Ke;Tang Jing;Yang Kun;Jiang Dechun;Su Su;Xing Xiaoxuan;Yan Suying(Department of Pharmacy,Xuanwu Hospital,the First Clinical Medical College of Capital Medical University,Beijing 100053,China;National Clinical Research Center for Geriatric Disorders;Department of Evidence-based Medicine,Xuanwu Hospital,the First Clinical Medical College of Capital Medical University)

机构地区：[1]首都医科大学宣武医院药学部,北京100053 [2]国家老年疾病临床医学研究中心 [3]首都医科大学宣武医院循证医学中心

出　　处：《药物流行病学杂志》2022年第1期38-44,共7页Chinese Journal of Pharmacoepidemiology

基　　金：北京市科学技术委员会课题项目(编号:D181100000218002)。

摘　　要：目的:调查住院老年慢病患者多重用药情况并评估多重用药的影响因素和后果。方法:在中国14个省27家三级医院开展多重用药现状横断面调查。从医院电子病历系统中收集数据,计算患者的查尔森合并症指数并且评估患者是否使用了潜在不适当用药。对各省数据进行地区差异分析。采用Logistic回归模型分析多重用药的影响因素。结果:纳入研究的1249例患者中91.6%存在多重用药情况,50.4%的患者用药超过10种。查尔森合并症指数越高[OR=1.33,95%CI(1.07,1.64),P=0.009],出院诊断数越多[OR=1.09,95%CI(1.01,1.19),P=0.035],越易发生多重用药。高血压[OR=2.13,95%CI(1.37,3.30),P<0.001]和冠心病[OR=1.77,95%CI(1.04,3.00),P=0.035]患者多重用药发生率较高。合并三种及以上慢病的患者多重用药风险更高(P<0.001)。多重用药增加了潜在不适当用药(P<0.001)、药物不良反应发生(P=0.024)的可能性,延长了住院时间(P<0.001)并且增加了医疗费用(P<0.001)。华北地区和华南地区多重用药及潜在不适当用药的发生率均较高而西北地区最低(P<0.001)。结论:中国住院老年慢病患者普遍存在多重用药现象,亟需采取强有力的干预措施来减少多重用药,改善患者用药问题。Objective:To investigate the polypharmacy of elderly patients with chronic diseases in multiple regions in China,and to evaluate the influencing factors and outcomes of polypharmacy.Methods:A cross-sectional survey of the status of polypharmacy was conducted in 27 tertiary hospitals from 14 provinces in China.Data were collected from the Hospital Electronic Medical Record System.The Charlson Comorbidity Index and potential inappropriate medications were assessed.And we analyzed regional variation in data from various provinces.Logistic regression model was used to analyze the influencing factors of polypharmacy.Results:Of the 1249 patients studied,91.6%were on polypharmacy and 50.4%on hyperpolypharmacy.Higher Charlson Comorbidity Index(OR=1.33,95%CI 1.07 to 1.64,P=0.009)and more discharge diagnoses(OR=1.09,95%CI 1.01 to 1.19,P=0.035)promoted polypharmacy.Patients with hypertension(OR=2.13,95%CI 1.37 to 3.30,P<0.001)and coronary atherosclerotic heart disease(OR=1.77,95%CI 1.04 to 3.00,P=0.035)were more likely to be on polypharmacy.Patients with three or more coexisting chronic conditions had a higher prevalence of polypharmacy(P<0.001).Polypharmacy was associated with potentially inappropriate medications(P<0.001)and adverse drug reactions(P=0.024),prolonged hospital stays(P<0.001),and increased medical costs(P<0.001).The rate of polypharmacy and potential inappropriate medications was higher in North China and South China and the lowest in Northwest China(P<0.001).Conclusion:Polypharmacy are common among elderly inpatients with chronic diseases in China.There is an urgent need to implement strong interventions to reduce polypharmacy and improve drug use.

关 键 词：老年人 多重用药 慢性病 潜在不适当用药 药品不良反应 

分 类 号：R969.3[医药卫生—药理学]