老年精神科患者潜在不适当用药评价及列线图预测模型的建立

Evaluation of potentially inappropriate medication in elderly psychiatric patients and the establishment of a nomogram prediction model

目的探索影响老年精神科患者潜在不适当用药因素,并构建列线图预测模型。方法回顾性分析2022年3月至2024年2月在浙江省衢州市第三医院就诊的389例精神科老年患者的病历资料,评估患者潜在不恰当用药情况,经Logistic回归模型分析影响潜在性不恰当用药的独立因素,并使用列线图预测模型效能。结果389例精神科患者中,常用药为氯氮平片、舒必利片、利培酮片,而潜在风险因子最高的药物为氯氮平片。联合用药数>3种、共患疾病数≥3种、部分自费、住院时间>14 d是影响精神科患者药品潜在性不适当用药的独立因素(P<0.05)。构建列线图,C-index为0.99,经过1000次内部校准后,真实值和预测值吻合度绝对误差为0.016。经Bootstrap法内验证,预测模型曲线下面积(AUC)为0.870,95%CI(0.815,0.926),Hosmer-Lemeshow拟合优度检验为3.749(P>0.05)。结论住院时间、付费方式、共患疾病数、联合用药数是导致老年精神科患者潜在不适当用药的独立因素,临床上可针对高危因素适当调整患者用药情况,以降低潜在性不适当用药风险。

Objective To explore the potential inappropriate medication situation of elderly psychiatric patients,and construct a nomogram prediction model to analyze the influencing factors.Methods A retrospective analysis of 389 elderly psychiatric patients in Quzhou Third Hospital were collected from March 2022 to February 2024 to assess the potential for inappropriate drug use.A binary Logistic regression model was used to analyze the independent factors affecting the potential for inappropriate drug use,and a nomogram was used to predict the efficacy of the model.Results Among the 389 psychiatric patients,clozapine tablets,sulpiride tablets and risperidone tablets were commonly used,while the drug with the highest potential risk factor was clozapine tablets.According to the binary Logistic regression analysis,the results showed that the number of combination drugs>3 kinds,3 kinds of comorbid diseases,some self-paid expenses,and hospitalization days>14 d were independent factors affecting the potentially inappropriate medication of psychiatric patients(P<0.05).The nomogram was constructed from independent factors with a C-index of 0.99.After 1000 internal calibrations,the absolute error of true and predicted agreement was 0.016.By the Bootstrap method,the AUC of the prediction model was 0.870,95%CI(0.815,0.926),and the Hosmer-Lemeshow goodness-of-fit test was 3.749(P>0.05).Conclusion The length of hospital stay,payment method,number of comorbidities,and types of combined medication are independent factors leading to potentially inappropriate medication in elderly psychiatric patients.Clinically,the above high-risk factors can be used to appropriately adjust patients′medication to reduce the risk of potentially inappropriate medication.