社区全科门诊老年高血压患者潜在不适当用药情况及影响因素分析

Potential inappropriate medication and its influencing factors among elderly hypertensive patients in community general practice clinic

目的调查社区全科门诊老年高血压患者潜在不适当用药(PIM)情况并分析其影响因素。方法选取北京市某社区卫生服务中心全科门诊2020年11月至2021年8月老年高血压患者处方767张,应用《中国老年人潜在不适当用药判断标准(2017年版)》筛查PIM发生情况,并分析PIM的影响因素。结果在767张老年高血压患者处方中检出198张(25.8%)处方、244例次PIM。PIM检出率前3位的是苯二氮?类-艾司唑仑64例次,氯吡格雷53例次,胰岛素35例次。按照是否应用PIM药物进行分组,单因素分析显示,用药种类、高血压合并血脂异常、冠心病、2型糖尿病、骨关节病、上呼吸道感染、失眠具有统计学意义(χ^(2)=82.58、13.65、17.74、7.52、10.34、68.19,均P<0.05)。再将这些因素纳入多因素logistic回归分析显示,用药种类、高血压合并上呼吸道感染、失眠是PIM发生的影响因素(OR=1.55、2.47、9.05,均P<0.05)。结论社区全科门诊老年高血压患者PIM发生较普遍,用药种类、高血压合并上呼吸道感染、失眠是PIM发生的影响因素。提示社区全科医生应提高对PIM识别,尽量精简处方,选择新型药物或非药物治疗替代,减少PIM发生。

Objective:To investigate the status quo of potentially inappropriate medication (PIM) among elderly hypertensive patients in community general practice clinic and related influencing factors.Methods:A total of 767 prescriptions for elderly hypertensive patients in a community health service center in Beijing from October 2020 to August 2021 were reviewed. The prevalence of PIM was assessed based on the criteria of potentially inappropriate medications for older adults in China(2017). Logistic regression analysis was employed to analyze the influencing factors for PIM. Results:The survey showed that 198 elderly patients had PIM with 244 person-doses. The top three drugs with high rate of PIM were benzodiazepine-estazolam (64 person-doses), clopidogrel (53 person-doses) and insulin (35 person-doses). Univariate analysis showed that PIM was significantly associated with types of medication;and underlying diseases hypertension with hyperlipidemia, coronary heart disease, type 2 diabetes, osteoarthritis, upper respiratory tract infection and insomnia (χ^(2)=82.58, 13.65, 17.74, 7.52, 10.34, 68.19,respectively,all P<0.05). Multivariate logistic regression analysis showed that the types of medication, hypertension complicated with upper respiratory tract infection, and insomnia were independent influencing factors for PIM ( OR=1.55, 2.47, 9.05;P<0.05). Conclusion:The study shows that PIM is more common in elderly hypertensive patients in community general practice clinics,which is associated with types of medication, hypertension complicated with upper respiratory tract infection and insomnia. It is suggested that general practitioner working in community clinics should be aware of PIM, minimize the number of prescription drugs, and choose new drugs or non-drug treatments to reduce the occurrence of PIM.