综合内科老年住院患者潜在不适当用药发生情况及影响因素分析

Analysis of the occurrence and influencing factors of potentially inappropriate medications in elderly inpatients in department of general internal medicine

目的探讨综合内科老年住院患者潜在不适当用药(PIM)发生情况及其影响因素。方法收集北京同仁医院综合内科2019年1月1日至12月31日出院老年患者(≥65岁)的病历资料,分别采用美国老年医学会2019年版Beers标准(2019 AGS Beers标准)和《中国老年人潜在不适当用药判断标准(2017年版)》(2017中国标准)评价患者住院期间的PIM发生情况,并将患者按性别、年龄(<75、≥75岁)、合并疾病种数(≤5、6~9、≥10种)、用药种数(1~4、5~9、≥10种)和住院时间(≤7、8~14和≥15 d)分组比较PIM的发生情况,采用logistic回归方法分析PIM的影响因素,计算比值比(OR)及其95%置信区间(CI)。结果纳入分析的患者共511例,男性257例,女性254例;年龄65~103岁,中位年龄为75岁;用药数2~75种,中位数为18种;合并疾病1~27种,中位数为11种;住院时间3~73 d,中位数为12 d。依据2019 AGS Beers标准评价,PIM发生率为56.56%(289/511),共涉及30种药品、618例次用药,占比在前3位的药物为利尿剂(42.72%,264/618)、苯二氮类及其受体激动剂(16.34%,101/618)和抗胆碱能药物(12.62%,78/618)。依据2017中国标准评价,PIM发生率为55.19%(282/511),共涉及31种药品、496例次用药,占比在前3位的药物为苯二氮类及其受体激动剂(20.36%,101/496)、茶碱类(19.96%,99/496)和氯吡格雷(17.34%,86/496)。logistic回归分析结果显示,年龄≥75岁、用药种数≥5种、合并疾病≥10种以及住院时间>7 d是发生PIM的危险因素(均P<0.001)。结论 2019年我院综合内科超过半数的老年住院患者存在PIM,高龄、联用多种药物、合并多种疾病和住院时间超过1周是PIM的危险因素。

Objective To explore the occurrence of potentially inappropriate medication(PIM)and its influencing factors in elderly inpatients in department of general internal medicine.Methods The medical record data of elderly patients(≥65 years)discharged from the Department of General Internal Medicine in Beijing Tongren Hospital,Capital Medical University between January 1st and December 31st,2019 were collected.The occurrence of PIM in these patients during hospitalization was evaluated according to the 2019 Beers Criteria of the American Geriatric Association(2019 AGS Beers criteria)and Criteria of Potentially Inappropriate Medications for Older Adults in China(2017 Chinese criteria).Patients were grouped according to their gender,age(<75,≥75 years),number of diseases(≤5,6-9,210),number of drugs(1-4,5-9,≥10),and length of hospital stay(≤7,8-14,>15 d)and the occurrence of PIM between the groups was compared.Logistic regression was used to analyze the influencing factors of PIM,and the odds ratio(OR)and its 95%confidence interval(CT)were calculated.Results A total of 511 patients were included in the analysis.Of them,257 were males and 254 were females,aged 65-103 years with a median age of 75 years;the number of drugs ranged from 2 to 75,with a median number of 18;number of diseases ranged from 1 to 27,with a median number of 11;length of hospital stay ranged from 3 to 73 days,with a median time of 12 days.According to the 2019 AGS Beers criteria,the incidence of PIM was 56.56%(289/511),involving 30 drugs and 618 times of drug administration.The top 3 drugs were diuretics(42.72%,264/618),benzodiazepines and benzodiazepine receptor agonists(16.34%,101/618),and anticholinergic drugs(12.62%.78/618).According to the 2017 Chinese criteria,the incidence of PIM was 55.19%(282/511),involving 31 drugs and 496 times of drug administration.The top 3 drugs were benzodiazepines and benzodiazepine receptor agonists(20.36%,101/496),theophylline drugs(19.96%,99/496),and clopidogrel(17.34%,86/496).The results of logistic regression analysis showed that age(>75 years),number of drugs(≥5),number of diseases(≥10),and length of hospital stay(>7 days)were risk factors for PIM(P<0.001 for all).Conclusions The incidence of PIM in elderly in patients in Department of General Internal Medicine in our hospital were similar using the 2 criteria,but the drugs involved were different.Using different criteria to evaluate PIM can complement each other and help pharmacists find more PIM.