门诊老年患者潜在不适当用药情况及影响因素分析  

Prevalence and Associated Factors of Potentially Inappropriate Medication among Elderly Outpatients

作　　者：段妍琴 彭颖[1] 刘胜兰 刘海姣 杨慧琼[2] 胡海清 DUAN Yanqin;PENG Ying;LIU Shenglan;LIU Haijiao;YANG Huiqiong;HU Haiqing(Department of Pharmacy,Changsha Hospital of Hunan Normal University(the Fourth Hospital of Changsha),Changsha 410006,China;Department of General Practice,Changsha Hospital of Hunan Normal University(the Fourth Hospital of Changsha),Changsha 410006,China)

机构地区：[1]湖南师范大学附属长沙医院(长沙市第四医院)药学部,湖南省长沙市410006 [2]湖南师范大学附属长沙医院(长沙市第四医院)全科医学科,湖南省长沙市410006

出　　处：《中国全科医学》2023年第31期3902-3907,共6页Chinese General Practice

基　　金：湖南省科技厅普惠性政策与创新环境建设计划项目(2021ZK4137)。

摘　　要：背景我国人口老龄化日益加剧,老年人多病共存及多重用药现象增多,故其发生药物相互作用及药物不良反应的风险较高。目前我国对老年人潜在不适当用药(PIM)的研究较少,临床上老年人的PIM问题尚未得到充分重视。目的依据2019年版Beers标准回顾性分析门诊老年患者PIM发生情况及影响因素,为临床老年患者合理用药提供更精准的用药指导。方法2022-01-10,利用湖南师范大学附属长沙医院的“智慧药学平台”调取2021年1—12月门诊老年患者处方,采用2019年版Beers标准对每张处方进行独立评价,分析PIM发生情况。采用多因素Logistic回归分析PIM的影响因素。结果本研究共收集39275张处方,患者平均年龄为(74.0±6.8)岁,平均疾病诊断种数为(1.49±0.81)种,平均用药种数为(2.70±1.75)种。PIM发生率为31.72%(12458/39275),与药物相关的PIM 11134次,与疾病相关的PIM 23次,老年患者慎用药物的PIM 2109次,老年患者应避免的药物间相互作用的PIM 99次,肾功能不全老年患者须避免使用的PIM 2次、须减少用药剂量的PIM 8次。处方PIM发生率较高的科室为神经内科1908次(61.17%)、老年病科972次(49.49%)、全科医学科1495次(42.21%),主要涉及的药物为苯二氮类药物、质子泵抑制剂、口服非甾体抗炎药和格列苯脲等。多因素Logistic回归分析显示,老年患者发生PIM的独立危险影响因素为年龄、疾病诊断种数和用药种数(P<0.05)。结论患者年龄增大、疾病诊断种数和用药种数增加是PIM发生的主要危险因素,临床医师和药师应对此予以重视,做好潜在用药风险筛查,促进合理用药。Background China's aging adults are increasing,and have increasing prevalence of multimorbidity and polypharmacy,leading to a high risk of drug-drug interactions and adverse drug reactions.There are few studies on potentially inappropriate medication(PIM)in the elderly,and PIM in this group has not yet received sufficient attention clinically.Objective To perform a retrospective analysis of the PIM prevalence and associated factors in elderly outpatients in a hospital using the 2019 Updated AGS Beers Criteria■for Potentially Inappropriate Medication Use in Older Adults(hereinafter referred to as the 2019 Beers Criteria),providing precise medication guidance for clinical rational use of medications in the elderly.Methods Prescriptions of older outpatients written from January to December 2021 were collected from the"Smart Pharmacy Platform"of Changsha Hospital of Hunan Normal University on January 10,2022.Each prescription was evaluated independently to find whether there was a PIM using the 2019 Beers Criteria.Multivariate Logistic regression was used to analyze the associated factors of PIM.Results The prescriptions of 39275 outpatients were collected in the analysis,who had an average age of(74.0±6.8)years,an average number of diagnosed illnesses of(1.49±0.81),and an average number of types of drugs used of(2.70±1.75).The overall prevalence of PIM was 31.72%(12458/39275),involving 11134 cases of drug-related PIM,23 cases of disease-or symptom-related PIM,2109 cases of medication should be used with caution-related PIM in elderly patients,99 cases of drug-drug interactions-related PIM that should be avoided in elderly patients,2 cases of avoiding drug-related PIM and 8 cases of reducing drug-dose-related PIM in elderly patients with renal insufficiency.The departments with higher incidence of prescribing PIM were neurology〔1908(61.17%)〕,geriatrics〔972(49.49%)〕,and general medicine〔1495(42.21%)〕.The major prescribed PIM included benzodiazepines,proton pump inhibitors,oral nonsteroidal anti-inflam

关 键 词：门诊病人 老年人 潜在不适当用药 Beers标准 质量保证 卫生保健 影响因素分析 

分 类 号：R197[医药卫生—卫生事业管理]