斋堂社区老年人潜在不适当用药及其相关因素

Potentially inappropriate medication among the elderly in Zhaitang Community and its related factors

摘要:

目的 使用不同潜在不适当用药(PIM)标准调查乡镇社区门诊PIM现状,分析PIM与医师处方、患者自身疾病及认知功能障碍等因素的关系,帮助提高乡镇门诊老年人合理用药水平。方法 采取横断面研究,纳入北京市门头沟区斋堂社区卫生服务中心门诊长期就诊老年患者264例,收集患者年龄、共病情况[疾病数量、查尔森共病指数(CCI)]、口服药、认知功能状态等资料。分别以中国老年人潜在不适当用药判断标准2017版(标准1)、美国Beers标准2019版(标准2)、联合使用中国老年人潜在不适当用药判断标准和美国Beers标准(标准3)确定PIM。将患者分为PIM组和非PIM组,调查不同标准PIM检出率,对比2组患者年龄、共病情况、认知功能状态等差异。应用SPSS 23.0软件包进行统计分析,分别应用χ²检验、独立样本t检验、非参数检验、Pearson相关分析、Spearman相关分析等对数据进行统计分析。结果 共入选患者264例,年龄(71.7±5.9)岁。标准1、标准2、标准3 PIM检出率逐渐增高,分别为28.4%、39.0%、50.8%。以标准3确定的PIM分组与男性(OR=1.941,95%CI 1.110~3.394, P=0.020)、CCI(OR=1.470,95%CI 1.115~1.939, P=0.006)、口服药种类(OR=1.241, 95%CI 1.056~1.459, P=0.009)、认知功能障碍(OR=3.686,95%CI 1.448~9.382, P=0.006)等相关,而与年龄无相关性。结论 乡镇门诊老年人PIM高发,联合使用中国和美国PIM标准可以提高PIM检出率,PIM与口服药种类、自身疾病严重程度和认知功能障碍相关。医师应联合使用中外PIM标准加强对存在共病、认知功能障碍老人的合理用药筛查,减少乡镇门诊老年人潜在不适当用药。

Abstract:

Objective To investigate, using different criteria of potentially inappropriate medication (PIM), status quo of PIM and to analyze the relationship between PIM and doctors′ prescriptions, patients′ diseases, cognitive dysfunction and other factors with a view of improving rationality in clinical drug use for the elderly outpatients in townships. Methods A cross-sectional study was conducted of 264 elderly patients who received long-term treatment in Zhaitang Community Health Service Center in Mentougou District, Beijing. Data were collected on their age, comorbidity [number of diseases, Charson comorbidity index (CCI)], oral medications and cognitive function. The PIM was identified by the Chinese Criteria for Potentially Inappropriate Drug Use in Elderly People 2017 (criteria 1), the Beers Criteria 2019 (criteria 2) and the combined criteria of the Chinese and the Beers (criteria 3). Patients were divided into PIM group and non-PIM group by three criteria. PIM rate was explored, and the two groups were compared in age, multimorbidity, cognitive function status and other factors. Statistical analysis was performed using SPSS statistics 23.0. Data were analyzed with χ² test, independent sample t test, non-parametric test, Pearson correlation analysis, and Spearman correlation analysis. Results A total of 264 patients were included in the study, aged (71.7±5.9) years. PIM detected by the three criteria were increased gradually, 28.4% for criteria 1,39.0% for criteria 2 and 50.8% criteria 3. PIM with criteria 3 was found to be associated with male gender (OR=1.941,95%CI 1.110-3.394, P=0.020), CCI (OR=1.470,95%CI 1.115-1,939, P=0.006), types of oral medication (OR=1.241,95%CI 1.056-1.459, P=0.009) and cognitive dysfunction (OR=3.686,95%CI 1.448-9.382,P=0.006), but not with age.Conclusions The incidence of PIM is high among the elderly outpatients in the township, and the combined Chinese and American PIM criteria can improve its PIM detection. PIM is associated with the types of oral medication, the severity of the diseases and cognitive dysfunction. Doctors should use both Chinese and foreign criteria to strengthen screening for the reasonable drug use among the elderly with multimorbidity and cognitive dysfunction, thus reducing PIM among the elderly in the township.