基于不同标准的门诊老年患者潜在不适当用药情况及风险因素

Evaluation of potentially inappropriate medication and analysis of risk factors among elderly outpatients based on different criteria

目的采用不同标准对门诊老年患者潜在不适当用药(PIM)情况及风险因素进行分析。方法回顾性收集哈尔滨医科大学附属第一医院群力院区2023年7—9月老年患者(年龄≥65岁)门诊处方,依照2023版Beers标准及2017版中国PIM标准分析PIM发生情况,通过Kappa一致性检验分析两种标准检出PIM的一致性,采用多因素logistic回归分析老年患者发生PIM的影响因素。结果共纳入14597份有效处方,其中,2023版Beers标准PIM检出率为15.39%,高于中国PIM标准检出率(13.33%),差异具有统计学意义(χ^(2)=20.186,P<0.01)。结合两种标准,PIM发生率最高的药物为中枢神经系统类药物(包括苯二氮䓬类药物、抗抑郁药、抗精神病药等)、阿司匹林、氯吡格雷及胰岛素。Kappa一致性检验结果证实,两种标准检出PIM的一致性较差(κ=0.395)。多因素logistic回归分析结果表明,基于Beers标准,老年患者发生PIM的影响因素为性别、年龄、疾病种数和药品品种数(P<0.05);基于中国PIM标准,老年患者发生PIM的影响因素为年龄、疾病种数和药品品种数(P<0.05)。结论门诊老年患者发生PIM较为普遍,尤其需要关注中枢神经系统类药物。基于两种标准的研究结果均提示老年患者发生PIM的主要风险因素为年龄、疾病种数和药品品种数;两种标准PIM阳性检出率一致性较差,在临床实践中应注意将两种标准结合应用。

Objective To evaluate potentially inappropriate medication(PIM)and risk factors among elderly outpatients based on different criteria.Methods Prescriptions of elderly outpatients(aged over 65 years)from Qunli Hospital District of the First Affiliated Hospital of Harbin Medical University were retrospectively collected from July to September of 2023.2023 AGS Beers Criteria and 2017 Chinese PIM Criteria were used to determine PIM incidence.Kappa consistency test was used to analyze the consistency between the two criteria.Multivariate logistic regression analysis was performed to identify risk factors related to PIM in elderly patients.Results A total of 14597 prescriptions were included.The PIM incidence based on 2023 Beers Criteria was 15.39%,significantly higher than the incidence(13.33%)using the Chinese PIM Criteria(χ^(2)=20.186,P<0.01).Combining the two criteria,the drugs with the highest PIM incidence were CNS drugs(including benzodiazepines,antidepressants,antipsychotics,etc.),aspirin,clopidogrel,and insulin.Kappa consistency test revealed the poor consistency between the two criteria in detecting PIM(κ=0.395).Multivariate logistic regression analysis showed that,based on 2023 Beers Criteria,sex,age,number of diagnosed disease and number of types of medication were independent risk factors of PIM(P<0.05).Similarly,based on the Chinese PIM Criteria,age,number of diagnosed diseases,and number of types of medication were independent risk factors of PIM(P<0.05).Conclusion PIM is prevalent among elderly outpatients especially for CNS drugs.Both criteria indicated that age,number of diagnosed disease and number of types of medication are major risk factors for PIM in elderly patients.Given the poor consistency in PIM detection between the two criteria,a combined application of both is recommended in clinical practice.