神经内科老年患者潜在不适当用药评价及改进对策

Evaluation and Improvement of Potential Inappropriate Drug Use in Elderly Patients

目的探讨神经内科门诊老年(≥60岁)患者潜在不适当用药(PIM)特点及改进对策。方法回顾性分析2019年7月医院神经内科门诊老年患者处方的人口统计学、临床诊断、用药情况等资料,根据《中国老年人潜在不适当用药判断标准(2017年版)》分析处方中PIM情况。结果4272例神经内科老年患者处方中发生PIM 1647例(38.55%),共计1692例次,其中高风险药物317例次(18.74%),低风险药物1375例次(81.26%);A级警示药物1497例次(88.48%),B级警示药物195例次(11.52%);涉及20种药物,PIM发生率较高的有氯吡格雷、艾司唑仑、尼麦角林、劳拉西泮、奥氮平;特定疾病状态下发生的PIM涉及谵妄、痴呆或认知功能受损,主要涉及苯二氮类药物及抗精神病类药物。结论医院神经内科门诊老年患者仍存在PIM现象,药师对此应重视并积极干预,提高老年患者安全合理用药水平,保障临床用药安全。

Objective To investigate the potential inappropriate medication(PIM)use in elderly outpatients(≥60 years)from department of neurology and the corresponding countermeasures.Methods A retrospective investigation was conducted to analyze the demography,clinical diagnosis and medication of prescriptions of elderly patients in the outpatient department of neurology of a hospital in July2019.The prescription of PIM was analyzed according to the Criteria for Judging potential Inappropriate Drug Use among The Elderly in China(2017 edition).Results A total of 4272 elderly neurology outpatients were selected as subjects of study,of which 1647 cases(38.55%)contained PIM.The frequency of PIM was 1692,included 317(18.74%)high-risk drug use and 1375(81.26%)low risk drug use.There were 1497 cases(88.48%)of class A warning drugs and 195 cases(11.52%)of class B warning drugs.Twenty drugs were involved,and the drugs with higher incidence of PIM included clopidogrel,estazolam,nimergoline,lorazepam and olanzapine.PIM in specific disease states involved delirium,dementia,or impaired cognitive function,and the main drugs related drugs were benzodiazepines and psychotropic drugs.Conclusion There is still potential improper drug use in elderly patients in the outpatient department of neurology of the hospital,which should be paid attention to and actively intervened by pharmacists to improve the level of safe and rational drug use in elderly patients and ensure the safety of clinical drug use.