老年人部分基本药物用药临床综合评价

Comprehensive evaluation of the utilization of essential medicines among elderly people in clinic settings

目的:对我国老年人部分基本药物进行临床综合评价,旨在为老年人全额保障药品品种的选择提供参考。方法:采用专家咨询法对涉及神经系统用药、精神疾病用药、心血管系统用药、呼吸系统用药等8大系统58种国家基本药物安全性、有效性、医务人员给药顺应性、患者用药顺应性、临床价值综合评价以及药物经济学指标进行综合评价。结果:除精神系统用药评价外,其他系统用药评价的专家权威系数均大于0.7,表明专家对各系统用药指标的熟悉程度较高,咨询结果可信。根据指标的综合评分,可考虑将硝酸甘油、酒石酸美托洛尔、硝酸异山梨酯、奥美拉唑、二甲双胍、氨氯地平、阿司匹林、阿卡波糖、缬沙坦、氯吡格雷10种药物作为老年人全额保障药品的优先参考品种;硝苯地平、艾司唑仑、坦洛新(坦索罗辛)、辛伐他汀、阿法骨化醇、依那普利、比索洛尔、丙酸倍氯米松、异丙托溴铵、沙丁胺醇10种药物作为老年人全额保障药品的次选参考品种。结论:专家推荐的评分较高的药物以心血管系统疾病用药、内分泌、呼吸系统疾病用药为主,与老年人疾病谱相符;老年人全额保障基本药物遴选可考虑据筹资情况,优先从老年人使用频次较高且药品费用负担较重的几大类基本药物中挑选。

Objective To comprehensively evaluate the utilization of some essential medicines among elderly people in clinic settings in China,in order to provide a reference for the selection of fully reimbursed medicines for the elderly.Methods Expert consultations were conducted to evaluate the utilization of 58 essential medicines related to eight major therapeutic areas,including neurology,psychiatry,cardiovascular diseases,respiratory diseases,among elderly people.The evaluation indexes included safety,efficacy,compliance by medical staff,compliance by patients,clinical value,and pharmaceutical economics.Results Except for psychiatry,authority coefficients for drugs related to the other therapeutic areas were greater than 0.7,indicating that experts were familiar with the indications of the medications.According to the comprehensive evaluation scores,10 medicines,i.e.,nitroglycerin,metoprolol tartrate,isosorbide dinitrate,omeprazole,metformin,amlodipine,aspirin,acarbose,valsartan,and clopidogrel,could be considered as the first choices for guaranteed essential drugs for the elderly.Meanwhile,another 10 medicines,including nifedipine,estazolam,tamsulosin,simvastatin,alfacalcidol,enalapril,bisoprolol,beclomethasone dipropionate,ipratropium,and salbutamol,could be considered as the second choices for guaranteed essential drugs for elderly people.Conclusions The first choices recommended by experts as guaranteed essential drugs for the elderly are mainly cardiovascular,endocrine and respiratory medicines,in line with the disease spectrum of the elderly.The selection of essential medications with full cost reimbursement for elderly patients should be those frequently used and with a burden of high medicine costs.