终末期70岁及以上住院患者药物相关问题分析

Drug-related problems of hospitalized elderly patients with limited life expectancy

目的分析终末期老年(≥70岁)住院患者的药物相关问题(DRPs)的发生情况与特点。方法采用老年人1年内死亡率预测指数评分,对2015年1月至2021年12月北京协和医院老年医学科住院的261例次终末期老年患者,行基于DRPs Strand分类系统的DRPs类别、涉及药物、干预措施分析。结果261例次终末期老年住院患者中,187例次(71.6%)患者存在672个DRPs,最常见的DRPs为安全性问题,包括药物不良反应271个(40.3%)及剂量过高149个(22.2%)。DRPs共涉及207种药物,发生DRPs频率较高的前5类药物依次为全身用抗感染药(20.7%,139/672)、神经系统用药(19.4%,130/672)、消化道及代谢方面用药(16.5%,111/672)、心血管系统用药(16.1%,108/672)及血液和造血器官药(13.7%,92/672)。由药师对672个DRPs进行干预,医师接受率95.7%(643/672)。干预建议中564个为用药调整,108个为用药监护。在用药调整干预中,280个(49.6%,280/564)建议为处方精简(停药或减量),精简频率较高的药物分别为全身用抗菌药(29.6%,83/280)、调节血脂药(7.9%,22/280)及抗血栓形成药(7.9%,22/280)。重度失能与非重度失能的终末期患者相比,平均DRPs数量(2比1个)及平均处方精简数量(1比0个)显著升高(Z=-4.83,Z=-3.61,均P<0.001)。结论终末期老年患者药物安全性问题突出,重度失能的终末期患者面临更多的DRPs。

Objective To analyze drug-related problems(DRPs)of hospitalized elderly patients with limited life expectancy.Methods A total of 261 patients aged≥70 years with limited life expectancy according to the 1-year mortality prediction index,who were admitted in the geriatric ward of Peking Union Medical College Hospital from January 2015 to December 2021 were included.According to Strand system,the categories,medications and interventions of DRPs were analyzed.Results Among 261 patients,187(71.6%)had 672 DRPs.The most common DRPs were related to drug safety,including 271(40.3%)adverse drug reactions and 149 over dosages(22.2%).A total of 207 drugs were involved in DRPs,and the top 5 classes with higher frequency of DRPs were antiinfectives for systemic use(20.7%,139/672),nervous system drugs(19.4%,130/672),alimentary tract and metabolism drugs(16.5%,111/672),cardiovascular system drugs(16.1%,108/672),and blood and hemopoietic organs drugs(13.7%,92/672).The recommendations were given by pharmacists for all 672 DRPs,and 643 were accepted by physicians(95.7%).The therapy need to be adjusted in 564 recommendations and the medications need to be monitored in 108 recommendations.In recommendations of therapy adjustment,49.6%(280/564)were related to deprescribing.The deprescribing with higher frequency included antiinfectives for systemic use(29.6%,83/280),lipid modifying agents(7.9%,22/280)and antithrombotic agents(7.9%,22/280).Patients with severe disability had significantly higher average DRPs(2 vs.1)and average deprescribing(1 vs.0)than patients without severe disability(Z=-4.83,Z=-3.61,all P<0.001).Conclusion Drug safety is the most common DRP in limited life expectancy elderly inpatients,particularly for those with severe disability.