基层医院门诊老年患者疾病分布与多重用药相关影响因素的回顾性分析

Retrospective Analysis of Disease Distribution and Multiple Drug Use Related Factors in Elderly Outpatients of Primary Hospitals

目的探讨老年患者疾病分布与多重用药影响因素的相关性。方法采用回顾性分析法,基于医院信息系统提取我院2019年6~12月门诊患者的处方信息(包括患者性别、年龄、门诊/住院号)、临床诊断、治疗药物的种类与数量以及付款方式等数据进行统计分析。结果31488例门诊老年患者中,多重用药患者7886例(25.04%)。老年患者罹患疾病频次排序前五位依次为高血压13139次(31.51%)、糖尿病4678次(11.22%)、上呼吸道感染2451次(5.88%)、冠心病2403次(5.76%)、脑血管疾病1439次(3.45%)。多重用药患者中罹患疾病主要集中在高血压751例(2.39%)、上呼吸道感染858例(2.72%)、冠心病286例(0.91%)、高血压+糖尿病1119例(3.55%)、高血压+冠心病843例(2.68%)、高血压+脑血管疾病283例(0.9%)。多因素Logistic回归分析表明:职工特病(OR=1.113,95%CI=1.039~1.193,P=0.00)、年龄70~<80岁(OR=1.196,95%CI=1.126~1.270,P=0.00)、年龄≥80岁(OR=1.440,95%CI=1.339~1.549,P=0.00)及罹患2种及以上疾病(OR=3.836,95%CI=3.635~4.048,P=0.00)是多重用药的独立危险因素。结论门诊老年患者存在多重用药现象,应结合老年患者特点制定个体化治疗方案,精简处方用药治疗,提供科学合理的药学服务。

Objective To explore the correlation between disease distribution of elderly patients and the influencing factors of multiple drug use.Methods Based on the hospital information system,extracted and analysised the prescription information(including patient gender,age,outpatient/inpatient number),clinical diagnosis,type and quantity of treatment drugs and payment methods and payment method of our hospital from June to December 2019.Results Among the 31488 outpatients,7886 cases(25.04%)were multiple drug uses.The top 5 frequencies of suffering diseases were followed by 13139(31.51%)of hypertension,4678(11.22%)of diabetes,2451(5.88%)of upper respiratory tract infection,2403(5.76%)of coronary heart disease and 1439(3.45%)of cerebrovascular disease.Diseases in the multi-drug patients were mainly concentrated in 751 cases of hypertension(2.39%),858 cases of upper respiratory tract infection(2.72%),286 cases of coronary heart disease(0.91%),1119 cases of hypertension+diabetes(3.55%),843 cases of hypertension+coronary heart disease(2.68%),283 cases of hypertension+cerebrovascular disease(0.9%).Multivariate Logistic regression analysis showsed:employee specific disease(OR=1.113,95%CI=1.039-1.193,P=0.00),age 70-<80 years(OR=1.196,95%CI=1.126-1.270,P=0.00),age≥80 years old(OR=1.440,95%CI=1.339-1.549,P=0.00)and suffering from two and more diseases(OR=3.836,95%CI=3.635-4.048,P=0.00)were independent risk factors for multiple drugs.Conclusion There is a phenomenon of multiple drug use in elderly outpatients.We should make individualized treatment plan based on the characteristics of elderly patients,simplify the prescription drug treatment,and provide scientific and reasonable pharmaceutical services.