全科医师面对老年共病患者多重用药的应对策略

General Practitioners'Coping Strategies for Polypharmacy in Elderly Patients with Multimorbidity

老年患者常多病共存,用药种类繁多,易引起药物不良反应(ADR),产生诸多危害,同时加重了患者经济负担。本文总结了老年共病患者多重用药的现状及多种危害,提出组建由药师参与的全科诊疗团队对老年共病患者实行综合评估,应用Beers标准及药物适宜性指数(MAI)为其制定合理的诊疗方案。全科医师应做好老年共病患者的社区随访工作,及时调整用药方案,监测用药的安全性,采用加强医疗照护、物理疗法等非药物措施减少多重用药,从而提高患者的生活质量。

Polypharmacy-induced adverse reactions and hazards are common in elderly patients with multimorbidity.At the same time,the economic burden is increased.We summarized the status and various hazards of polypharmacy in this group,and based on this,proposed that formulating a rational diagnostic and therapeutic regimen should be using Beers Criteria and medication appropriateness index(MAI)after comprehensive patient assessment by the general practice team with at least a pharmacist included.And the regimen should be modified timely according to general practitioner-delivered community-based follow-up results.Moreover,medication safety should be monitored.In addition,to reduce polypharmacy,non-drug interventions such as strengthened medical care and physical therapy can be used,so that the quality of life of the patients may be improved.