老年慢病患者用药风险的影响因素分析

Analysis of factors influencing the risk of medication use in elderly patients with chronic diseases

目的了解老年慢病患者用药风险的影响因素,为优化全民健康、合理用药、养老服务等相关政策提供参考。方法于2022年3月,采取方便抽样法,选取17家不同等级医疗机构的60岁及以上老年慢病患者进行问卷调查,内容包括患者一般资料和对于用药风险的认知、行为情况,根据自行设计的评估量表得分评估患者用药风险。采用SPSS 27.0统计软件进行t检验、单因素方差分析、χ^(2)检验和多因素logistic回归分析。结果发放问卷1000份,实际回收有效问卷752份,其中男性367人(48.80%),女性385人(51.20%),用药高风险425人(56.52%),用药低风险327人(43.48%)。老年慢病患者用药风险认知及行为的平均得分分别为(1.97±0.99)和(2.82±1.12)分。多因素logistic回归分析结果显示,年龄≥65岁(OR=2.155,95%CI:1.477~3.146)与用药风险正相关(P<0.01),就诊于二级医疗机构(OR=0.555,95%CI:0.367~0.841)和三级医疗机构(OR=0.294,95%CI:0.203~0.428)、高中及以上学历(OR=0.476,95%CI:0.366~0.619)、接受过药学服务(OR=0.127,95%CI:0.064~0.254)与用药风险负相关(P<0.05,P<0.01)。相对于华北地区,居住在东北地区(OR=1.998,95%CI:1.274~3.133)、华东地区(OR=2.409,95%CI:1.535~3.780)、西南地区(OR=4.095,95%CI:2.671~6.277)或西北地区(OR=1.829,95%CI:1.125~2.972)与用药风险正相关(P<0.05,P<0.01)。相对于事业单位工作人员,工人(OR=1.686,95%CI:1.196~2.377)、个体工商人员(OR=2.047,95%CI:1.315~3.186)或农民(OR=2.158,95%CI:1.561~2.983)与用药风险正相关(P<0.01)。结论老年慢病患者用药高风险比例较高,应加强安全用药知识的宣传和科普,提升药学服务覆盖范围和能力水平,重点关注年龄≥65岁,居住在东北、华东、西南或西北地区,职业为工人、个体工商人员或农民的人群,降低用药风险。

Objective To understand the influencing factors of medication risk in elderly patients with chronic diseases in order to provide a reference for optimising policies related to health for all,rational medication use,and services for the elderly.Methods In March 2022,a questionnaire survey was conducted among elderly chronic disease patients aged 60 years old and above in 17medical institutions of different grades by convenience sampling method,which included patients'general information and their knowledge and behaviour of medication risk,and patients'medication risk was assessed based on the scores of a self-designed assessment scale.The t test,one-way analysis of variance,χ^(2)test and multi-factor logistic regression analysis were performed using SPSS 27.0 statistical software.Results 1000 questionnaires were distributed and 752 valid questionnaires were actually collected,of which 367(48.80%)were males and 385(51.20%)were females,425 elderly patients(56.52%)were at high risk of medication use and 327 elderly patients(43.48%)were at low risk of medication use.The mean scores of medication risk perception and behaviour of elderly chronic patients were(1.97±0.99)and(2.82±1.12)respectively.Results of multifactorial logistic regression analysis showed that age≥65 years old(OR=2.155,95%CI:1.477-3.146)was positively associated with the risk of medication use(P<0.01).Attending secondary care(OR=0.555,95%CI:0.367-0.841),tertiary care(OR=0.294,95%CI:0.203-0.428),high school and above(OR=0.476,95%CI:0.366-0.619),and receiving pharmacy services(OR=0.127,95%CI:0.064-0.254)were negatively associated with the risk of medication use(P<0.05,P<0.01).Compared with North China,living in Northeast China(OR=1.998,95%CI:1.274-3.133),East China(OR=2.409,95%CI:1.535-3.780),Southwest China(OR=4.095,95%CI:2.671-6.277)or Northwest China(OR=1.829,95%CI:1.125-2.972)was positively associated with the risk of medication use(P<0.05,P<0.01).Compared with being a white-collar worker,being a blue-collar worker(OR=1.686,95%CI:1.196-2.377),a self-employed businessman(OR=2.047,95%CI:1.315-3.186)or a farmer(OR=2.158,95%CI:1.561-2.983)was positively associated with the risk of medication use(P<0.05).Conclusion Elderly patients with chronic diseases have a high proportion of high risk of medication use,and publicity and popularisation of knowledge about safe medication use should be strengthened to improve the coverage and competence level of pharmacy services,with a focus on the population aged≥65 years,residing in Northeast,East,Southwest or Northwest China,and with occupations of workers,self-employed industrial and commercial workers or farmers,in order to reduce the risk of medication use.