临床药师干预老年住院患者潜在不适当用药的效果评价

Effect Evaluation of Intervention on Potentially Inappropriate Medication in Elderly Inpatients by Clinical Pharmacists

目的:评价航天中心医院老年住院患者潜在不适当用药(PIM)情况,探索临床药师开展PIM药学干预的工作模式,为保障老年患者合理用药提供理论和实践依据。方法:通过单中心队列研究,以2021年1—6月于航天中心医院住院的老年患者为研究对象。根据临床药师是否开展药学干预,分为干预组和对照组。应用《中国老年人潜在不适当用药判断标准(2017年版)》(以下简称《标准》),评价两组患者的PIM情况,分析临床药师改善PIM的效果。结果:共纳入符合纳入、排除标准的患者455例,其中干预组214例,对照组241例。为消除两组间混杂因素影响,采用倾向性评分来平衡组间差异。匹配后,干预组患者164例,对照组患者164例,共328例患者。根据《标准》,257例患者(占78.35%)至少发生1种PIM,人均PIM为1(1~2)项。有效性方面,与对照组相比,干预组患者的PIM发生率(P=0.023)、人均PIM(P=0.024)和90 d全因再入院率(P=0.032)均明显降低,差异均有统计学意义;经济性方面,与对照组相比,干预组患者平均治疗费用明显降低,差异有统计学意义(P=0.022)。结论:临床药师开展老年住院患者药学干预,不仅可降低PIM发生率、人均PIM和90 d全因再入院率,还可降低治疗费用,提高老年患者临床用药合理性。

OBJECTIVE: To evaluate the potentially inappropriate medications(PIM) in elderly inpatients in the Aerospace Center Hospital, and probe into the work pattern of PIM pharmaceutical intervention conducted by clinical pharmacists, so as to provide theoretical and practical basis for ensuring rational medication in elder patients. METHODS: Through a single center cohort study, the elder patients hospitalized in the Aerospace Center Hospital from Jan. to Jun. 2021 were selected as research objects. These patients were divided into intervention group and control group based on whether the clinical pharmacists carried out pharmaceutical intervention. The Criteria of Potentially Inappropriate Medications for Older Adults in China(2017 version)(hereinafter referred to as the Criteria) was applied to evaluate the PIM of both groups and analyze the effect of PIM improvements by clinical pharmacists. RESULTS: A total of 455 patients who met the inclusion and exclusion criteria were enrolled in the research, including 214 patients in the intervention group and 241 patients in the control group. To eliminate the effect of confounding factors between two groups, propensity score was used to balance the between-group differences. After matching, there were 164 cases in the intervention group and 164 cases in the control group, a total of 328 patients. By applying the Criteria, 257 patients(78.35%) had at least 1 PIM, with 1(1 to 2) PIM per capita. In terms of effectiveness, the incidence of PIM(P=0.023), PIM per capita(P=0.024) and 90 d all-cause readmission rate(P=0.032) were significantly lower in the intervention group compared with the control group, with statistically significant differences;in terms of economy, the average treatment cost of patients in the intervention group was significantly lower compared with the control group, with statistically significant difference(P=0.022). CONCLUSIONS: Pharmaceutical intervention on elderly inpatients by clinical pharmacists can not only reduce the incidence of PIM, per capita PIM and 90 d all-cause readmission rate, but also reduce the treatment cost of patients and improves the rationality of clinical medication in elderly patients.