摘要
目的了解我国城市医院门急诊老年患者潜在不适当用药（PIM）情况及影响因素。方法门急诊老年（≥65岁）患者处方采集自“医院处方分析合作项目”中参与该项目并定期提交完整处方信息的北京、上海、广州、天津、杭州、成都的79家医院，调查时段为2014年1月1日至12月31日，每个季度各抽取10个工作日的门急诊老年患者所有处方，记录处方基本信息（就诊城市、医院等级、性别、年龄、就诊科室、主要疾病/疾病状态）和用药信息（药物名称、规格、剂型、剂量、合并用药种数），分别依据中国老年人PIM目录（中国目录，收录72种药物）和2012版Beers标准（Beers标准，收录124种药物，其中100种在国内上市）分析处方PIM情况，采用多元Logistic回归方法分析PIM影响因素。结果共采集处方2 962 232张，男性患者处方1 499 201张，女性患者处方1 463 031张；患者年龄65～120岁，平均（75±7岁）；每例单科室均次就诊开具药物1～15种，平均（2.2±1.5）种。根据中国目录和Beer标准判断，PIM处方检出率分别为15.81%（468 228/2 962 232）和9.16%（271 250/2 962 232）（P〈0.001），PIM药物检出比例分别为90.28%（65/72）和70.00%（70/100）（P〈0.001），高风险强度或高推荐强度/高证据等级PIM药物检出比例分别为85.71%（30/35）和67.50%（27/40）（P=0.065）；检出1种PIM药物的处方分别占PIM处方的91.83%（429 977/468 228）和92.79%（251 696/271 250）；处方数排名前10位的PIM药物分别为氯吡格雷、艾司唑仑、阿普唑仑、多沙唑嗪、尼麦角林、唑吡坦、双氯芬酸、胰岛素、奥氮平、华法林和艾司唑仑、阿普唑仑、多沙唑嗪、特拉唑嗪、唑吡坦、双氯芬酸、美洛昔康、奥氮平、氯硝西泮、螺内酯。多元Logistic回归分析显示，就诊城市、医院等级、性别、年龄、就诊科室、药物种数、疾病/疾病状态均为门
Objective To understand the situation and influencing factors of potentially inappropriate medication （PIM） in elderly patients in outpatient and emergency departments in China. Methods Prescriptions for patients aged ≥65 years with complete prescribing information from 79 hospitals in six cities including Beijing, Shanghai, Guangzhou, Tianjin, Hangzhou and Chengdu from February 1st,2014 to December 31st, 2014 were collected. All prescriptions for elderly patients of 10 working days in each quarter were collected and the basic information （including region, hospital grade, gender, age, department, and major disease/disease status） and medication information （including drug name, drug specification, drug dosage form, drug dose, and the number of combined drugs ） were recorded. The situation and influencing factors of PIM in elderly patients based on the Chinese PIM list and 2012 Beers criteria were analyzed. Results A total of 2 962 232 prescriptions were collected, of them, 1 499 201 were for male patients and 1 463 031 ones for female patients. The ages were from 65 to 120 years and the average age was （75 ± 7） years. The number of combined drugs were 1-15 and the average number was 2.2 ±1.5. According to the Chinese PIM list （ Chinese list, including 72 drugs） and 2012 Beers criteria （Beers criteria,including 124 drugs and 100 of them were in the Chinese market）, the detection proportion of prescriptions for elderly patients containing PIM in outpatient and emergency departments were 15.81% （468 228/2 962 232）and 9. 16% （271 250/2 962 232）, respectively （P 〈 0. 001 ）; the detection proportion of PIM varieties in prescriptions were 90.28% （65/72）and 70.00% （70/100）, respectively （P 〈 0. 001 ） ; the detection proportion of PIM varieties with high risks or high recommendation and high evidence levels were 85.71% （30/35） and 67.50% （27/40）, respectively （P =0. 065）. The proportion of prescriptions with one inappropriate medication in all PIM prescr
出处
《药物不良反应杂志》
CSCD
2017年第1期22-30,共9页
Adverse Drug Reactions Journal
基金
国家卫生部卫生行业科研专项（201002011）
北京市卫生系统高层次卫生技术人才培养计划（2011-1-7）志谢中国医学科学院北京协和医院李大魁教授牵头的《医院处方分析合作项目》提供数据,北京医院药剂科胡欣教授、北京大学医学部公共卫生学院流行病与卫生统计学系詹思延教授在研究方法和统计分析方面给予指导.
关键词
潜在不适当用药目录
老年人
中国
Potentially inappropriate medication list
Elderly
China
