基于中国老年人潜在不适当用药判断标准评价门诊老年患者用药  

Assessment of Drug Use among Elderly Outpatients by Criteria for Potentially Inappropriate Medications in China

作　　者：刘子祺 雷宁 李成敏 赵瑞萍 宋云龙 张帆 LIU Zi-qi;LEI Ning;LI Cheng-min;ZHAO Rui-ping;SONG Yun-long;ZHANG Fan(Rocket Force Characteristic Medical Center of PLA,Beijing 100088,China)

机构地区：[1]火箭军特色医学中心,北京100088

出　　处：《解放军药学学报》2022年第4期365-369,共5页Pharmaceutical Journal of Chinese People's Liberation Army

基　　金：部委级保健专项科研课题,20BJZ14。

摘　　要：目的探讨某院门诊老年患者潜在不适当用药特点,为临床合理用药提供参考。方法回顾性分析2019年3月-2020年2月门诊老年(60~99岁)患者病例,根据《中国老年人潜在不适当用药判断标准(2017年版)》进行统计。对患者的性别、年龄、疾病种数、联合用药种类、支付形式、处方医师职称、处方月份、处方科室等影响因素进行χ^(2)检验和多因素Logistic回归分析,评估老年门诊患者潜在不适当用药状况。结果218224例合并处方中,潜在不适当用药39512例,占比18.11%。潜在不适当用药发生例数最多的药物依次为氯吡格雷(31.91%)、胰岛素(15.37%)、艾司唑仑(14.92%)。老年潜在不适当用药占比较高科室依次为心血管内科、内分泌科、神经内科、骨科、呼吸内科、特殊门诊、泌尿外科、口腔科,8个科室老年潜在不适当用药累积百分比为90.38%。男性、年龄≥70岁、疾病种数≥2种、联合用药≥2种、全自费/地方医保、处方月份12月-次年2月、部分科室(心血管内科、内分泌科、骨科、泌尿外科、口腔科)是潜在不适当用药的独立危险因素(P<0.05)。结论《中国老年人潜在不适当用药判断标准(2017年版)》更符合中国老年人用药特点,对于潜在不适当用药高风险患者,进行处方时应权衡利弊、谨慎用药。Objective To investigate the potentially inappropriate medications(PIMs)among elderly outpatients treated in the Characteristic Medical Center of PLA Rocket Force in order to ensure rational use of drugs in clinic.Methods The clinical data on elderly outpatients aged 60 to 99 and treated between March 2019 and February 2020 was retrospectively analyzed and their PIMs were assessed by related crite-ria in China.Theχ^(2) testing and multivariate logistic regression were used to analyze such influencing factors as gender,age,types of diseases,types of drugs used in combination,ways of payment,profes-sional titles of clinicians,the month in which prescriptions were made,and the departments concerned.Results A total of 218224 cases were collected,and PIMs accounted for 18.11%(39512 cases).Clopidogrel ranked the first in terms of PIMs(31.91%),followed by insulin(15.37%)and estazolam(14.92%).These cases of PIMs involved departments of cardiology,endocrinology,neurology,orthopaedics,respiratory medicine,special clinics,urology and stomatology.The cumulative percentage of PIMs in the eight departments was 90.38%.Masculinity,age over 70,two or more types of diseases,two or more types of drugs used in combination,ineligibility for insurance or local insurance,prescriptions made between December and February,and some departments(cardiovascular medicine,endocrinology,orthopaedics,urology,stomatology)were independent risk factors for elderly PIMs(P<0.05).Conclusion Chinese criteria for elderly PIMs basically conform to the characteristics of drug use among the elderly in China.High-risk PIMs deserve more attention.

关 键 词：老年患者 潜在不适当用药 用药评价 

分 类 号：R969.3[医药卫生—药理学]