基于Beers标准和STOPP/START标准评价神经内科老年患者出院带药处方潜在不适当用药情况

Evaluation of potentially inappropriate medication in discharge prescriptions of elderly patients in neurology department using Beers criteria and STOPP/START criteria

目的考察Beers标准(2019版)和老年人不适当处方筛查工具/处方遗漏筛查工具标准(2014版)(STOPP/START标准)对神经内科患者出院带药处方不适当用药评估的适用性,分析发生潜在不适当用药(PIM)和潜在处方遗漏(PPO)的影响因素。方法收集浙江大学医学院附属金华市中心医院神经内科2021年8—12月出院患者病历,以Beers标准和STOPP/START标准为评价依据对患者出院带药处方进行分析,采用二项logistic回归模型分析发生PIM和PPO的影响因素,采用Kappa检验分析2种评价标准对PIM筛查结果的一致性。结果共纳入461例老年患者,平均年龄(74.89±7.20)岁,平均疾病诊断(11.07±3.57)种,平均出院带药(7.50±2.81)种。依据Beers标准,共检出223例(48.37%)存在PIM,合计481例次;依据STOPP标准,共检出183例(39.70%)存在PIM,合计276例次;依据START标准,共检出114例(24.73%)存在PPO,合计162例次。2种标准对神经内科患者PIM的筛查结果具有中等程度的一致性(Kappa=0.493,P<0.01)。多因素logis⁃tic回归分析结果显示,基于Beers标准,女性(OR=1.873,95%CI:1.261~2.783)和出院带药种数(OR=1.296,95%CI:1.192~1.409)是PIM发生的影响因素;基于STOPP标准,女性(OR=1.738,95%CI:1.159~2.605)、出院带药种数(OR=1.281,95%CI:1.179~1.391)、住院时间(OR=1.064,95%CI:1.007~1.124)是PIM发生的影响因素;基于START标准,年龄(OR=1.050,95%CI:1.017~1.083)和住院时间(OR=1.124,95%CI:1.060~1.193)是PPO发生的影响因素。结论Beers标准和STOPP/START标准在评估神经内科患者出院带药处方PIM方面具有重要的参考价值,Beers标准较STOPP标准PIM检出率高,联合使用2种标准有利于全面评估患者PIM情况。

Objective To investigate the applicability of Beers criteria(version 2019)and Screening Tool of Older Per⁃sons′Prescriptions/Screening Tool to Alert to Right Treatment(STOPP/START)criteria(version 2014)in the evaluation of inap⁃propriate medication in discharge prescriptions of the Neurology Department and analyze the influencing factors of potentially inappropriate medication(PIM)and potential prescription omission(PPO).Methods Patients discharged from the Neurology Department of Affiliated Jinhua Hospital,Zhejiang University School of Medicine from August to December 2021 were collect⁃ed.Beers and STOPP/START criteria were invoked as evaluation basis to analyze the patients′discharge medication.Binomial logistic regression model was utilized to analyze the influencing factors of PIM and PPO.Kappa test was used to analyze the consistency of the two evaluation criteria on screening PIM.Results A total of 461 elderly patients were included,with aver⁃age age of(74.89±7.2)years,average number of diseases diagnoses of(11.07±3.57),and average number of discharge medication of(7.50±2.81).According to Beers criteria,PIM occurred in 223 patients(48.37%)with a total case of 481.Ac⁃cording to STOPP criteria,PIM occurred in 183 patients(39.70%)with a total case of 276.According to START criteria,PPO occurred in 114 patients(24.73%)with a total case of 162.There was moderate consistency between the two criteria in the judgment on PIM(Kappa=0.493,P<0.01).Multivariate logistic regression analysis suggested that female(OR=1.873,95%CI:1.261-2.783)and number of discharge medication(OR=1.296,95%CI:1.192-1.409)were risk factors when using Beers cri⁃teria to screen PIM,female(OR=1.738,95%CI:1.159-2.605),number of discharge medication(OR=1.281,95%CI:1.179-1.391)and length of stay(OR=1.064,95%CI:1.007-1.124)were risk factors when using STOPP standard to screen PIM,and age(OR=1.050,95%CI:1.017-1.083)and length of stay(OR=1.124,95%CI:1.060-1.193)were risk factors when using START criteria to screen PPO.Conclusion Beers and STOPP/START criteria have principal reference value in evaluating PIM of discharge medication in neurology department patients.More PIMs can be detected using Beers criteria compared to STOPP criteria.The combined use of the two criteria facilitate a comprehensive assessment of potentially inappropriate medication for patients.