高龄住院患者潜在不适当用药调查及影响因素分析

Survey on potentially inappropriate medications in very old hospitalized patients and analysis of influencing factors

摘要:

目的 联合Beers标准和老年人不适当处方筛查工具(STOPP)标准对高龄住院患者潜在不适当用药(PIM)发生率进行调查,并探讨其影响因素。方法 回顾性分析2015年1月至2020年12月在解放军总医院第二医学中心住院且年龄≥80岁的患者1 023例。应用Beers标准(2019版)和STOPP标准(2014版)筛查PIM发生情况。采用SPSS 22.0统计软件进行数据分析。采用logistic回归分析PIM的影响因素。结果 Beers 标准筛查出811例(79.3%)患者存在PIM。STOPP标准筛查出605例(59.1%)患者存在PIM。2种筛查标准一致性较低(Kappa＝0.238,P<0.001)。2种标准筛查结果显示,PIM使用频率最高的药物均为苯二氮〖XC；%85%85〗类。老年人处方遗漏筛查工具标准筛查出541例(52.9%)患者存在用药遗漏。logistic回归分析显示,年龄、查尔森合并症指数、联合用药数目是PIM发生的危险因素。结论 高龄住院患者PIM发病率高。Beers标准和STOPP标准联合应用可提高PIM检出率。

Abstract:

Objective To survey the prevalence of potentially inappropriate medication (PIM) in very old hospitalized patients by combining the 2019 American Geriatrics Society (AGS) Beers Criteria and 2014 Screening Tool of Older Persons′ Prescriptions (STOPP) Criteria, and investigate the influencing factors. Methods A retrospective analysis was carried out on the 1023 inpatients aged ≥ 80 years in the Second Medical Center of Chinese PLA General Hospital from January 2015 to December 2020. PIM prevalence was assessed based on the 2019 AGS Beers Criteria and 2014 STOPP Criteria. SPSS statistics 22.0 was used to perform the statistical analysis. Logistic regression analysis was employed to analyze the influencing factors for PIM. Results According to the 2019 AGS Beers Criteria and 2014 STOPP Criteria, the prevalence of PIM was 79.3% (811 cases) and 59.1% (605 cases), respectively. And the consistency of the 2 screening criteria was quite low (Kappa=0.238, P<0.001). The most frequently prescribed PIM was Benzodiazepines according to the both criteria. Screening Tool to Alert to Right Treatment (START) Criteria found that the potential prescribing omission (PPO) incidence was 52.9% (541 cases). Logistic regression analysis indicated that age, Charlson comorbidity index and number of concomitant medications were risk factors for PIM. Conclusion The prevalence of PIM is quite high in the very old hospitalized patients. Combining Beers and STOPP criteria are effective to enhance the detection of PIM.