基于浦东新区全科医师调研的老年共存病患者潜在不合理用药管理策略研究  

Potentially inappropriate medications management strategies for elderly patients with coexisting diseases based on the survey of general practitioners in Pudong New Area

作　　者：黄倩[1] 徐昕[1] 邵洁[1] 张芳[1] 蔡丞俊 黄蛟灵 刘葳 张胜冰 HUANG Qian;XU Xin;SHAO Jie;ZHANG Fang;CAI Chengjun;HUANG Jiaoling;LIU Wei;ZHANG Shengbing(Weifang Community Health Service Center,Pudong New Area,Shanghai 200122,China;不详)

机构地区：[1]上海市浦东新区潍坊社区卫生服务中心,上海200122 [2]上海交通大学医学院公共卫生学院,上海200025 [3]上海市黄浦区打浦桥社区卫生服务中心,上海200025

出　　处：《中华全科医学》2023年第6期911-915,共5页Chinese Journal of General Practice

基　　金：上海市浦东新区卫生健康委员会学科带头人培养计划(PWRd2021-08);国家自然科学基金项目(71904145);上海市浦东新区科技发展基金民生科研专项资金项目(PKJ2019-Y48)。

摘　　要：目的调查共存病老年患者出现潜在不合理用药(PIM)的医方原因,建立管理策略。方法对本项目组前期研究检验出社区PIM项目21项设计田野调查问卷,分为3个部分:(1)基本情况;(2)对21项共存病PIM的主观合理性评价;(3)对21项共存病PIM的日常频率自我评估,问卷采用李克特7点式量表。于2021年12月—2022年1月使用机械式抽样方法对上海市浦东新区47家社区卫生服务中心的在岗全科医生共计236名进行在线问卷调研。使用SPSS 23.0统计学软件进行统计分析,使用四象限分析对各条目的客观频率、主观合理性、主观频率自我评估进行两两分析。结果秩和检验显示21个潜在不合理用药条目客观出现频率与主观合理性评价相比,差异均有统计学意义(均P<0.01);建立21个PIM的日常出现频率自我评估总得分为因变量的线性回归分析,结果显示,各因素对PIM日常出现频率自我评估影响不显著(均P>0.05);四象限分析提示,苯二氮[艹卓]类药物使用相关PIM条目、非甾体抗炎药(NSAIDs)类药物使用相关PIM条目普遍属于第2、3象限(医生较不重视或自我评估出现频率较高)。结论目前全科医生尚缺乏对于共存病老年患者的潜在不合理用药管理和控制意识,应加强培训,建立规范的管理流程。Objective To investigate the causes of potentially inappropriate medications(PIM)in elderly patients with coexistent diseases and establish management strategies.Methods A field survey questionnaire was designed for 21 items of community PIM project.It is divided into three parts:(1)basic information;(2)subjective rationality evaluation of PIM in 21 coexisting diseases;(3)daily frequency of PIM in 21 coexisting diseases,which was self-assessed by using the Likert 7-point scale.From December 2021 to January 2022,a total of 236 general practitioners in 47 community health service centres in Pudong New Area of Shanghai were surveyed online by using mechanical sampling.SPSS 23.0 was used for statistical analysis,and four quadrant analyses were used to analyse the objective frequency,subjective rationality,subjective frequency and self-evaluation of each item.Results The rank sum test showed that the objective frequency of 21 PIM items were significantly different from those of subjective rationality evaluation(all P<0.01).Linear regression analysis was established using the total score of self-assessment of daily occurrence frequency of 21 PIMs as the dependent variable.Results showed that each factor had no significant effect on the self-assessment of daily occurrence frequency of PIM(all P>0.05).Four-quadrant analysis indicated that the PIM items related to the use of benzodiazepines and to the use of non-steroidal anti-inflammatory drugs(NSAIDs)generally belonged to the second and third quadrants(doctors paid less attention to them,or the frequency of self-evaluation was higher).Conclusion At present,general practitioners still lack the awareness of PIM management and control for elderly patients with coexisting diseases.They should strengthen training and establish a standardised management process.

关 键 词：共存病 老年患者 不合理用药 策略 

分 类 号：R473.59[医药卫生—护理学] R969.3[医药卫生—临床医学]