基于Beers标准评价365例老年住院患者潜在不适当用药

摘要

目的 调查分析某三甲医院老年住院患者潜在不适当用药发生情况,探讨影响老年患者发生潜在不适当用药的可能因素.方法 依据2012年版Beers标准,临床药师通过评价某院2014年1～6月365例年龄≥65岁老年住院患者用药处方,确定其潜在不适当用药发生率和影响因素,并对Beers标准未纳入的潜在药物相互作用和中药注射剂使用情况进行分析.结果 189例(51.78％)患者至少存在1种潜在不适当用药,74例(20.27％)患者使用了潜在药物相互作用的药物,273例(74.79％)患者使用了中药注射剂.影响老年人发生潜在不适当用药的影响因素为联合用药数、住院时间、年龄和查尔森并发症指数评分.老年患者潜在不适当用药发生率与潜在药物相互作用发生率和中药注射剂使用率具有显著相关性.结论 临床药师应结合所在医院(地区)患者的流行病学特征和临床用药特点,合理借鉴和运用Beers标准,关注临床并发症,重视药物相互作用,提醒医师和患者慎用中药注射剂,减少老年用药风险,促进老年合理用药.%Objective To explore possible impact factors through investigating and analyzing the occurrence of potentially inappropriate medications (PIMs) in elderly inpatients.Methods Clinical pharmacists evaluated 365 drug prescriptions for elderly inpatients older than or equal to 65-year-old from January to June of 2014 based on Beers criteria published in 2012,aimed at determining incidence and impact factors of potentially inappropriate medications as well as analyzing potentially drug interactions and service condition of traditional Chinese medicine injections that were not included in Beers criteria.Results A total of 189 subjects (51.78％) used no less than one potentially inappropriate medications.Seventy four subjects (20.27％) used drugs with potential drug interactions.Two hundred and seventy three patients (74.79％) used troditional Chinese Medicine Injections.The impact factors on potentially inappropriate medications in elderly inpatients included combined use of drugs,hospitalization days,age and Charlson Comorbidity Index scores.Taking PIMs was significantly positively correlated with the occurrence of potential drug interactions and service condition of traditional Chinese medicine injections.Conclusion According to characteristics of epidemiology and clinical medication use in the hospital or region,clinical pharmacists should refer to Beers criteria so as to pay attention to clinical complications of elderly inpatients.Moreover,clinical pharmacists should emphasize drug interactions and remind physicians and inpatients using traditional Chinese medicine injections cautiously,aimed at decreasing drug risks of elderly inpatients,and promoting reasonable drug use in elderly inpatients.