基于Beers标准分析成都市老年门诊患者潜在不适当用药及相关风险因素

Evaluation of Potentially Inappropriate Medication and Risk Factor Analysis in Elderly Outpatients in Chengdu Based on Beers Standards

目的:对成都市老年门诊患者潜在不适当用药(PIM)进行评估,并分析相关风险因素。方法:通过《医院处方分析合作项目》平台随机抽取2016~2018年成都市9家三级医疗机构老年科门诊患者处方,以2015版Beers标准为依据评价其PIM,并采用多因素Logistic回归分析探讨发生PIM的影响因素。结果:44461张处方中,有12050张处方至少存在一种类型的PIM,占总处方数27.10%。其中,苯二氮艹卓类药物检出最多。多因素Logistic回归分析结果表明,女性[OR=1.479,95%CI(1.4093,1.552),P<0.05]、年龄≥80岁[OR=1.461,95%CI(1.380,1.546),P<0.05]、患有3种及以上疾病[3~4种疾病OR=1.371,95%CI(1.294,1.452),P<0.05;5种及以上疾病OR=1.322,95%CI(1.237,1.414),P<0.05]、使用5种及以上药品[5~9种药品OR=2.525,95%CI(2.384,2.675),P<0.05;10种及以上药品OR=9.957,95%CI(8.645,11.468),P<0.05]的患者处方出现PIM的风险更高。结论:成都市老年门诊患者存在PIM的问题较为普遍,其中,中枢神经系统药物为老年患者发生PIM最常见的一类药物。临床上应注意这类药物的使用,尤其是年龄较大、合并疾病及使用药物较多的老年患者。

Objective:To evaluate the prevalence of potential inappropriateness medications(PIMs)in elderly outpatients in Chengdu and analyze the risk factors.Methods:Based on the Cooperation Project of Hospital Prescription Analysis,prescriptions of geriatrics outpatients were randomly selected from 9 hospitals in Chengdu from 2016 to 2018 to evaluate their PIMs based on the 2015 Beers standards,and multivariate Logistic regression analysis was used to investigate the influencing factors of PIM.Results:Of the 44461 prescriptions,12050(27.10%)contained at least one PIM.Among them,benzodiazepines were the most detected.Multivariate Logistic regression analysis showed that patients with female gender(OR=1.479,95%CI 1.409 to 1.552,P<0.05),aged 80 and above(OR=1.461,95%CI 1.380 to 1.546,P<0.05),with more than 2 kinds of diseases(3-4 kinds of diseases OR=1.371,95%CI 1.294 to 1.452,P<0.05;more than 5 kinds of diseases OR=1.322,95%CI 1.237 to 1.414,P<0.05)and more than 4 kinds of drugs(5-9 kinds of drugs OR=2.525,95%CI 2.384 to 2.675,P<0.05;more than 10 kinds of drugs OR=9.957,95%CI 8.645 to 11.468,P<0.05)had a higher prevalence of PIMs.Conclusion:PIMs were common in elderly outpatients in Chengdu.Among them,central nervous system drugs were the most common drugs for PIMs in elderly patients.Attention should be paid to the use of these drugs,especially in older patients with complicated diseases and multiple drugs.