门诊老年患者潜在不适当用药及相关影响因素分析

Prevalence and Related Factor Analysis of Potentially Inappropriate Medication Among Elderly Outpatients

关键词:  Beers标准  门诊老年患者  潜在不适当用药  多因素逻辑回归

Key words:  Beers criteria  elderly outpatients  potentially inappropriate medication  multiple factor logic regression

摘要:

目的 回顾性分析门诊老年患者潜在不适当用药（potentially inappropriate medication，PIM）情况，并从医院总体和各科室两方面对其影响因素进行分析，为临床合理用药提供参考。方法 以2015年版Beers标准为评价依据，对2016年1-6月期间年龄≥ 65岁的门诊老年患者PIM进行统计，利用χ²检验和多因素逻辑回归分析其影响因素，评估不同科室间老年患者PIM情况。结果 182 431个处方案例中，PIM处方案例为24 374（13.36%）例，主要分布于心血管内科、神经内科和精神科，所有科室中精神科PIM发生率最高（92.70%）；PIM发生例数最多的药物依次为利尿剂、苯二氮䓬类和SSRIs类药物，分别占总PIM处方案例的34.57%，27.77%和14.90%，且这3类药物在各科室的发生例数和发生率有很大不同；对比不同科室PIM处方案例，发现年龄、患疾病数与PIM发生在这些科室中正、负相关皆有，而联合用药数与PIM发生全部呈正相关关系。随着联合用药数增加，精神科PIM优势比增加幅度最大（114.7%），是全科医学科（最小25.4%）的4.5倍。结论 面对不同科室PIM发生的差异性，临床医师和药师应密切关注老年患者PIM相关因素，做好潜在用药风险筛查，促进合理用药。

Abstract:

OBJECTIVE To retrospectively analyze potential inappropriate medication(PIM) used among the elderly outpatients, to analyze its related risk factors from the hospital and the departments, and to provide the reference for using rational drug in clinical practice. METHODS The elderly outpatients with 65 years old or over were collected from January to June 2016, and their PIMs were determined by Beers Criteria 2015. The χ² testing and multivariate logistic regression were conducted to analyze the related risk factors of PIMs, and its varieties of the elderly patients in different departments were evaluated. RESULTS A total of 182 431 cases were collected, in which the number of PIM prescription cases were 24 374(13.36%). The PIM cases were mainly distributed in cardiovascular medicine, neurology and psychiatry departments. The highest PIM incidence was 92.70% in psychiatric department. The most commonly prescribed drugs in PIM cases were diuretics, benzodiazepines and SSRIs, and their ratios of the total PIM cases were 34.57%, 27.77% and 14.90%, respectively. The PIM case numbers and incidences of these drugs were different in different departments. Compared with the PIM cases among different departments, it was found that the prevalences of PIMs were positively or negatively correlated with the age or disease number increasing in these departments, but the prevalences of PIMs were all positively correlated with the overall numbers of drugs. The PIM odds ratio in psychiatry department was maximal increased by 114.7%, which was 4.5 times as much as its in general medicine department(minimal increased by 25.4%). CONCLUSION The clinicians and pharmacists should pay attention to the PIM related factors of the elderly patients with the different prevalences of PIMs in different departments, screen the potential risk of drug use, and promote rational clinical drug use.