老年人潜在不适当用药调查分析

Investigation and Analysis of Potential Inappropriate Drug Application Among the Elderly

目的:调查山东省立医院(以下简称"我院")门诊和住院老年患者潜在不适当用药情况,为医师和药师指导患者合理用药、提高药物治疗水平和保障老年患者用药安全提供参考。方法:参考美国Beers标准以及《中国老年人潜在不适当用药目录》,对我院300例保健门诊老年患者、100例住院老年患者的用药情况进行调查,并对潜在不适当用药情况进行分析。结果:300例保健门诊老年患者的平均年龄为82.2岁,平均每例用药3.12种;存在潜在不适当用药情况79例,主要涉及胰岛素、氯吡格雷及阿司匹林。100例住院老年患者的平均年龄为75.9岁,平均每例用药7.71种;存在潜在不适当用药情况43例,主要涉及阿普唑仑、氯吡格雷、阿司匹林及呋塞米。多重用药可导致的相互作用以代谢性相互作用为主,其中他汀类药物与氯吡格雷联合应用病例所占比例较高。结论:老年患者潜在不适当用药现象普遍存在,应加强宣教,注意个体化用药,强化高风险药物在老年患者中的使用监管;药师应积极、有针对性地开展药学监护;努力推进药物重整,优化用药结构,加强药物相互作用风险警示,保障用药安全。

OBJECTIVE: To investigate potential inappropriate drug application among the elderly in outpatient and inpatient of Shandong Provincial Hospital(hereinafter referred to as "our hospital"), so as to provide reference for physicians and pharmacists to guide patients to rational drug application, improve drug treatment level and ensure medication safety for elderly patients. METHODS: By reference to the US Beers standard and the Catalogue of Potentially Unsuitable Drugs for the Elderly in China, investigation on the drug application of 300 elderly outpatients and 100 elderly inpatients were conducted, and the potential inappropriate drug application was analyzed. RESULTS: The average age of 300 elderly patients in healthcare clinics was 82.2 years old, with averagely 3.12 kinds of drugs were applied;there were 79 cases of potential inappropriate drug application, mainly involved insulin, clopidogrel and aspirin. The average age of 100 hospitalized elderly patients was 75.9 years old, with averagely 7.71 kinds of drugs were applied;there were 43 cases of potential inappropriate drug medication, mainly involved alprazolam, clopidogrel, aspirin and furosemide. The interactions caused by polypharmacy were mainly metabolic interactions, of which the proportion of statins combined with clopidogrel was higher. CONCLUSIONS: The potential inappropriate drug application in elderly patients is widespread, which needs further propaganda and education and attention on individualized medication, and strengthen the application of high-risk drugs in elderly patients;pharmacists should actively carry out targeted pharmaceutic care;promote drug reformation, optimize drug administration structure, strengthen the risk warning of drug interactions, and ensure medication safety.