某院82例老年住院患者潜在不适当用药的现状及其相关因素分析与对策

Analysis on Current Situation and Related Factors of Potential Inappropriate Medication in 82 Elderly Inpatients in a Hospital and Countermeasures

目的:了解医院老年住院患者潜在不合理用药(PIM)现状,分析影响PIM的相关因素。方法:收集医院2020年7月—12月年龄≥60岁住院患者82例病历资料,按《中国老年人潜在不适当用药判断标准(2017年版)》要求,统计其不适当用药内容,并采用独立样本t检验和皮尔逊相关性分析,以确定PIM发生的相关危险因素。结果:入选的82例老年患者中,所患疾病有2~8种,治疗用药有1~19种;其中检测到≥1项PIM患者52例(占63.41%),涉及PIM 97项;与疾病相关的PIM的11例次占13.41%;PIM涉及神经系统、内分泌系统等11大类19种药物(胰岛素、艾司唑仑等药物排名前列);与非PIM组相比,PIM组患者年龄较大(76.0岁vs 72.1岁)、住院时间较长(11.1 d vs 6.7 d),共存病数(3.5种vs 2.4种)和用药种数(7.9种vs 4.4种)更多,经组间比较其差异有统计学意义(P<0.05);而PIM的发生与患者所患疾病数、用药种数间存在极为显著的强正相关(P<0.01)。结论:老年住院患者PIM发生率较高,相同疾病和用药种数是PIM的危险因素;医院管理部门应采用信息化手段和相关标准,强化事前干预;医生和药师应重视PIM,精简用药数量,密切关注多病、多药患者的个体化给药监护,以确保老年患者用药安全性和合理性。

Objective: To investigate the current situation of potentially inappropriate medications(PIM) in elderly inpatients in a hospital, and to analyze the related factors influencing PIM. Methods: The medical records of 82 hospitalized patients aged ≥ 60 years old from July to December in 2020 were collected. Based on the Criterion for the PIM in the elderly in China(2017 Edition), the contents of inappropriate drug use were statistically analyzed, and independent sample(t test) and Pearson correlation analysis were used to determine the risk factors for PIM. Results: In 82 elderly patients, there were between 2 and 8 kinds of co-morbidity diseases and 1 and 19 kinds of therapeutic drugs. In them, 52 patients greater than or equal to 1 PIM were detected, accounting for 63.41%, and 97 PIM were involved. 11 cases of disease-related PIM accounted for 13.41%;PIM involves 19 drugs in 11 categories such as nervous system and endocrine system(insulin, estazolam and other drugs rank in the TOP). Compared with non-PIM group, PIM group had older age(76.0 years vs 72.1 years), longer hospital stay(11.1 days vs 6.7 days), co-morbidity diseases(3.5 vs 2.4 kinds) and more drug types(7.9 vs 4.4 kinds), and the difference between the two groups was statistically significant(P<0.05). There was a strong positive correlation between the occurrence of PIM and the number of diseases and types of drugs(P<0.01). Conclusion: The incidence of PIM in elderly inpatients was higher, and the same disease and the number of drugs used were the risk factors for PIM. Hospital management departments should adopt information means and relevant standards to strengthen pre-intervention. Doctors and pharmacists should pay attention to PIM, reduce the amount of drug usage, and pay close attention to the individualized administration of drug supervision as well as care for patients with multiple diseases and drugs, so as to ensure medication safety and rationality of drug use in elderly patients.