Beers标准(2019)和药物适宜性指数对老年患者多重用药评估及干预的临床观察  

Clinical observation of evaluation and intervention with Beers criteria(2019)and medication appropriateness index(MAI)for elderly patients with polypharmacy

作　　者：李晶[1] 赵氚 田海涛 Li Jing;Zhao Chuan;Tian Haitao(The Sixth Healthcare Department,the Second Medical Center,Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第二医学中心保健六科,北京100048 [2]解放军总医院医疗保障中心药剂科 [3]解放军总医院第六医学中心老年医学科

出　　处：《中华保健医学杂志》2023年第1期76-78,共3页Chinese Journal of Health Care and Medicine

基　　金：解放军总医院第六医学中心创新培育基金(HZKY-PJ-22020-10)。

摘　　要：目的探索医药联合立体管理模式能否改善老年患者的不合理用药。方法 选取2019年11月~2021年11月解放军总医院第六医学中心278名患者,随机数表法分为干预组(150名)和对照组(128名),干预组由老年病科医师和临床药师联合管理,采用Beers标准(2019版)及药物适宜性指数(medication appropriateness index,MAI)对入组后的患者每周进行处方审查和干预,待出院后每月电话或门诊随访。临床药师不参与对照组的任何工作。6个月后收集研究数据。结果 经临床医师和临床药师联合干预后,干预组人均服药的数量从(10.38±3.61)下降至(9.373±3.397),人均潜在不合理用药(Potentially inappropriate medication,PIM)由1.31(1.23)例次下降至0.76(0.84)例次,MAI评分由1.0(1.0)降至0.5(0.5),Barthel评分由90(40)升至95(35)。干预组MAI和Barthel评分的改善程度较对照组差异有统计学意义(P <0.05)。两组患者的再入院率和临床不良事件的发生率差异无统计学意义(P> 0.05)。结论 医药联合立体管理老年患者多重用药的模式,采用Beers标准(2019)和MAI能够有效的改善处方的质量,减少潜在不适当用药,提高患者日常生活能力,但对再入院率和临床的不良事件无影响。Objective To explore a three-dimensional managed model for the collaboration of geriatrics and pharmacists in elderly patients with polypharmacy,whether can improve prescription.Methods The study enrolled 278 patients,who were randomly divided into intervention group(150 patients)and control group(128 patients).The geriatrics and pharmacists jointly intervened polypharmacy in intervention group with Beers criteria(2019)and MAI,while geriatrics independently managed control group.The data was collected after 6 months.Results The group who received the collaborated intervention of geriatrics and pharmacists,whose drugs number decreased from(10.38±3.61)to(9.373±3.397)per person,potential inappropriate medication(PIM)decreased from 1.31(1.23)to 0.76(0.84)per person,MAI decreased from 1.0(1.0)to 0.5(0.5),and Barthel index increased from 90(40)to 95(35).Compared with the control group,the extent of MAI and Barthel index improvement was more significantly in the intervention group.The readmission and adverse clinical events did not differ between the two groups.Conclusions The three-dimensional managed polypharmacy model for the collaboration of geriatrics and pharmacists,using Beers criteria(2019)and MAI,can effectively improve prescription by reducing MAI,PIM,and significantly raised patients'daily living quality,but have no effect on adverse clinical events.

关 键 词：多重用药 干预模式 潜在不适当用药 Beers标准 药物适宜性指数 

分 类 号：R592[医药卫生—老年医学]