基于北京市医保中心数据库的4种老年慢病患者门诊多重用药现状调查  

A survey on current status of polypharmacy in elderly patients with 4 types of chronic diseases in outpatient clinics based on Beijing medical insurance Center data

作　　者：伍诗琪 主雪鹭 苏甦[1] 马文瑶 王春光 闫素英[1] 岳小林 Wu Shiqi;Zhu Xuelu;Su Su;Ma Wenyao;Wang Chunguang;Yan Suying;Yue Xiaolin(Department of Pharmacy,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Disorders,Beijing 100053,China;Peking University Clinical Research Institute,Beijing 100191,China;Puhua Health Cooperation,Beijing 100143,China)

机构地区：[1]首都医科大学宣武医院药学部,国家老年疾病临床医学研究中心,北京100053 [2]北京大学临床研究所,北京100191 [3]普华和诚(北京)信息有限公司,北京100143

出　　处：《药物不良反应杂志》2023年第10期584-591,共8页Adverse Drug Reactions Journal

基　　金：北京市科技计划项目(D181100000218002);北京市老年病医疗研究中心科研项目(1100002222T000000444688)。

摘　　要：目的调查门诊高血压病、糖尿病、冠状动脉粥样硬化性心脏病(冠心病)、脑血管病等4种老年慢病患者的多重用药现状。方法对北京市医保中心数据库中2017年7月至9月就诊的老年(≥65岁)高血压病、糖尿病、冠心病、脑血管疾病门诊患者的用药情况进行回顾性研究。纳入患者至少患有高血压病、糖尿病、冠心病、脑血管疾病4种慢病中的一种,首次就诊时用药品种数≥5种为多重用药,<5种为非多重用药。以查尔森合并症指数(CCI)对共病数目及严重程度进行量化,按照患者预后情况分为0、1、2和≥3分(4级),数值越大严重程度越重。以2015版Beers标准为判断依据,采用普华和诚处方点评系统识别潜在不适当用药(PIM)问题。结果本研究共纳入405608例患者,中位年龄74(65~107)岁,204219例(50.35%)为女性;按患者用药种数分为多重用药组(113594例,28.01%)和非多重用药组(292014例,71.99%)。多重用药组CCI明显高于非多重用药组(P<0.001),多重用药组评分为1、2及≥3分者占比均明显高于非多重用药组,差异有统计学意义(均P<0.001)。在共病方面,多重用药组4种慢病患者的占比均高于非多重用药组(均P<0.001)。在伴随疾病中,多重用药组高脂血症、认知功能障碍、心力衰竭及骨质疏松者占比均大于非多重用药组(均P<0.001)。在就诊行为方面,多重用药组中位就诊次数高于非多重用药组[2(1,3)次比1(1,2)次,P<0.001]。在药品使用不适宜性评价方面,多重用药组存在PIM患者占比均高于非多重用药组,包括重复用药[4.60%(5227/113594)比1.54%(4486/292014)]、存在禁忌证[2.97%(3376/113594)比1.13%(3294/292014)]、存在相互作用[6.51%(7399/113594)比1.94%(5658/292014)]和缺乏适应证[22.39%(25432/113594)比13.54%(39543/292014)]差异均有统计学意义(均P<0.001)。在药品使用类别方面,多重用药组被处方最多的药品类别排名前5位的依次为羟甲戊二酰辅酶A(HObjective To investigate the current status of polypharmacy among elderly outpa⁃tients with 4 types of chronic diseases such as hypertension,diabetes mellitus,coronary atherosclerotic heart disease,and cerebrovascular disease.Methods A retrospective study was conducted on the drug use of elderly(≥65 years old)outpatients with hypertension,diabetes mellitus,coronary atherosclerotic heart disease,and cerebrovascular disease with data of Beijing Municipal Health Insurance Centre database from July 2017 to September 2017.The included patients had at least 1 of 4 types of chronicdiseases.Polypharmacy was defined as≥5 different types of medication at the first visit,and non⁃polypharmacy was defined as<5 types of medication.The number and severity of comorbidity were quantified using the Charlson Comorbidity Index(CCI),and the prognosis of patient was evaluated at 4 levels of 0,1,2,and≥3scores.The larger the value,the more severe the disease.Based on the Beers Criteria 2015,the potential inappropriate medication(PIM)was identified using the prescription review system of Puhua Health.Results A total of 405608 patients were included in this study,with a median age of 74(65⁃107)years,and 204219 patients(50.35%)were female.According to the type of medication used by patients,they were divided into polypharmacy group(113594 cases,28.01%)and non⁃polypharmacy group(292014 cases,71.99%).The CCI of the polypharmacy group was significantly higher than that of the non⁃polypharmacy group(P<0.001).The proportion of patients with 0,1,2,and≥3 scores in the polypharmacy group was significantly higher than that of the non⁃polyphar⁃macy group,and the differences were statistically significant(all P<0.001).In terms of comorbidity,the proportions of patients among the 4 types of chronic diseases were higher in the polypharmacy group than in the non⁃polypharmacy group(P<0.001).In terms of concomitant diseases,the proportion of patients with hyperlipidemia,cognitive impairment,heart failure,and osteoporosis in the pol

关 键 词：老年人 潜在不适当用药目录 高血压病 糖尿病 冠状动脉疾病 脑血管病 处方不适宜 多重用药 

分 类 号：R95[医药卫生—药学]