基于Beers标准和STOPP/START标准评价住院老年患者的潜在不适当用药及其影响因素

Evaluation of potentially inappropriate medication and its influencing factors in geriatric patients based on Beers and STOPP/START criteria

目的 回顾性分析住院老年患者潜在不适当用药(potentially inappropriate medication,PIM)情况及其影响因素,为老年患者临床用药提供参考。方法 选取2021年5月至2022年5月于衢州市中医医院内科住院的年龄≥65岁的患者228例,以Beers标准(2019版)和老年人处方筛查工具(screening tool of older persons’prescriptions,STOPP)/提醒正确治疗的筛查工具(screening tool to alert to right treatment,START)标准为依据,判断老年患者PIM情况,并分析老年患者发生PIM的影响因素。结果 住院老年患者平均年龄(78.4±6.8)岁,平均住院时间(19.2±7.2) d,平均疾病种类(5.8±2.4)种,平均用药种类(6.6±2.3)种。依据Beers标准,84例(36.8%)患者共筛查出115项PIM;依据STOPP标准,68例(29.8%)患者存在85项PIM;依据START标准,20例(8.8%)患者存在20项处方遗漏现象。多因素Logistic回归分析结果显示,年龄≥80岁、疾病种类>3种、住院时间>15d、用药种类>3种均是PIM发生的危险因素(P<0.05)。结论 住院老年患者的PIM发生率较高;年龄、住院时间、疾病种类、用药种类是老年住院患者PIM发生的重要因素。使用Beers标准和STOPP/START标准对老年住院患者用药进行评价,能有效降低PIM的发生,促进老年患者合理用药。

Objective To retrospectively analyze the situation and influencing factors of potentially inappropriate medication(PIM)in geriatric inpatients,so as to provide reference for clinical medication in geriatric patients.Methods A total of 228 patients aged≥65 years who were hospitalized in the Internal Medicine Department of Quzhou Hospital of Traditional Chinese Medicine from May 2021 to May 2022 were selected.According to the Beers criterion(2019 edition)and screening tool of older persons’prescriptions(STOPP)/screening tool to alert to right treatment(START)criterion,the PIM of geriatric patients was judged,and the influencing factors of PIM were analyzed.Results The average age of hospitalized geriatric patients was(78.4±6.8)years,the average length of stay was(19.2±7.2)days,the average types of diseases were 5.8±2.4,and the average number of drugs was 6.6±2.3.According to Beers criteria,there were 84 cases(36.8%)with 115 items of PIMs;according to STOPP criteria,there were 68 cases(29.8%)with 85 items of PIMs;and 20 cases(8.8%)with 20 items of potential prescription omission according to START criteria.Multivariate Logistic regression analysis showed that age≥80 years old,more than 3 types of diseases,more than 15 days of hospital stay,and more than 3 types of drugs were risk factors for PIM(P<0.05).Conclusion The incidence rate of PIM among the geriatric patients was relatively high.Age,length of stay,type of disease and type of medication are important factors for the occurrence of PIM in geriatric patients.Using Beers criterion and STOPP/START criteria to evaluate the use of drugs in geriatric patients can effectively reduce the occurrence of PIM and promote the rational use of drugs in geriatric patients.