两种标准在老年住院患者潜在不适当用药评价中的应用分析
|
摘要
分析我院老年住院患者的潜在不适当用药情况,探讨STOPP/START标准及《中国老年人潜在不适当用药判断标准》的适用性,为促进合理用药提供依据。分别以STOPP/START标准和《中国老年人潜在不适当用药判断标准》为依据,对我院1196例全科老年住院患者的潜在不适当用药情况进行分析。1196例患者平均年龄为(76.2±7.0)岁,平均用药品种数(15.7±6.5)种。根据STOPP/START标准,368例(占30.77%)患者存在潜在不适当用药现象共491项,其中涉及最多的药物是苯二氮艹卓类药物;293例(占24.50%)患者存在处方遗漏共354项,其中遗漏最多的是血管紧张素转化酶抑制剂未用于有冠心病(史)的患者。根据《中国老年人潜在不适当用药判断标准》,726例(占60.70%)患者存在药物相关的潜在不适当用药现象共1215项,其中在与药物相关的PIM中,涉及药物最多的是氯吡格雷;110例(占9.20%)患者存在疾病状态下的潜在不适当用药现象共116项,全为A级警示药物相关的PIM,其中涉及最多是高血压患者使用非甾体抗炎药。两种标准检出相同的PIM 258例(占21.58%),共320项,其中可能引起跌倒药物重复检出的频率最高。我院全科老年住院患者存在较多潜在不适当用药情况,并且STOPP/START标准与《中国老年人潜在不适当用药判断标准》在识别潜在不适当用药方面均具有重大意义,应联系实际,合理使用。
This study is to analyze the potential inappropriate drug use in elderly inpatients in a hospital and explore the applicability of the STOPP/START criteria and the criteria of potentially inappropriate medications for older adults in China(PIMOAC),so as to provide basis for promoting rational drug use.Based on the STOPP/START criteria and the criteria of PIMOAC,the potentially inappropriate medication of 1196 elderly general inpatients in the hospital was analyzed.The 1196 inpatients,who were(76.2±7.0)years old,took(15.7±6.5) kinds of drugs per patient.According to the STOPP/START,368 patients(30.77%) involved 491 potential inappropriate medications,of which the most involved were benzodiazepine drugs;293 cases(24.50%) had prescription omissions involved 354 items,among them,the most omissed were angiotensin converting enzyme inhibitors for patients with coronary artery diseases.According to the criteria of PIMOAC,726 patients(60.70%) had 1215 drug-related potentially inappropriate medications,mostly with clopidogrel;110 patients(9.20%) had 116 items associated with disease or condition,all potentially inappropriate medications(PIM) were associated with alert medications A,mostly with NSAIDs in hypertensive patients.The 2 standards detected the same PIM in 258 cases(21.58%) with 320 items,drugs that predictably increase the risk of falls were the most repeated detections.There are many potential inappropriate medications in general elderly inpatients in our hospital,and the STOPP/START criteria and the criteria of PIMOAC are of great significance in identifying potentially inappropriate medications,which should be applied in conjunction for rational use of drugs.
This study is to analyze the potential inappropriate drug use in elderly inpatients in a hospital and explore the applicability of the STOPP/START criteria and the criteria of potentially inappropriate medications for older adults in China(PIMOAC),so as to provide basis for promoting rational drug use.Based on the STOPP/START criteria and the criteria of PIMOAC,the potentially inappropriate medication of 1196 elderly general inpatients in the hospital was analyzed.The 1196 inpatients,who were(76.2±7.0)years old,took(15.7±6.5) kinds of drugs per patient.According to the STOPP/START,368 patients(30.77%) involved 491 potential inappropriate medications,of which the most involved were benzodiazepine drugs;293 cases(24.50%) had prescription omissions involved 354 items,among them,the most omissed were angiotensin converting enzyme inhibitors for patients with coronary artery diseases.According to the criteria of PIMOAC,726 patients(60.70%) had 1215 drug-related potentially inappropriate medications,mostly with clopidogrel;110 patients(9.20%) had 116 items associated with disease or condition,all potentially inappropriate medications(PIM) were associated with alert medications A,mostly with NSAIDs in hypertensive patients.The 2 standards detected the same PIM in 258 cases(21.58%) with 320 items,drugs that predictably increase the risk of falls were the most repeated detections.There are many potential inappropriate medications in general elderly inpatients in our hospital,and the STOPP/START criteria and the criteria of PIMOAC are of great significance in identifying potentially inappropriate medications,which should be applied in conjunction for rational use of drugs.
引文
[1]周海峰,沈杰,纪芳,等.Beers标准联合STOPPSTART准则评价我院内科老年住院患者潜在不适当用药[J].中国药房,2016,27(23):3212-4.
[2]Samuel MJ.American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults[J].J Am Geriatr Soc,2015,63(11):2227-46.
[3]O'Mahony D,O'Sullivan D,Byrne S,et al.STOPPSTART criteria for potentially inappropriate prescribing in older people:version 2[J].Age Ageing,2015,44(2)213-8.
[4]冯林林,童荣生,龙恩武,等.老年心血管病患者潜在性不适当用药及影响因素分析[J].中国医院药学杂志,2018,38(3):289-94.
[5]中国老年保健医学研究会老年合理用药分会,中华医学会老年医学分会,中国药学会.中国老年人潜在不适当用药判断标准(2017版)[J].药物不良反应杂志,2018,20(1):2-8.
[6]李影影,邢玉晶,王烨,等.Beers标准和STOPP/START标准再评价老年住院患者医嘱点评情况[J].药学与临床研究,2016,24(1):57-60
[7]段蓉,李正翔.2种标准评估老年住院患者潜在不适当用药[J].中国医院药学杂志,2017,37(19):1979-82,2000.
[8]蔡俊,聂力,张海霞,等.基于中国老年人潜在不适当用药目录评价老年住院患者不合理用药[J].中国临床药理学杂志,2018(3):375-7.
[9]国家卫生计生委合理用药专家委员会,中国药师协会.冠心病合理用药指南[J].中国医学前沿杂志(电子版),2016,8(6):19-108.
[10]Balamuthusamy S,Arora R.Hematologic adverse effects of clopidogrel[J].Am J Ther,2007,14(1):106-12.
[11]孔雪云,陈琦,吴祥,等.中西药联用相互作用研究进展[J].南京中医药大学学报,2018(1):5-11.
[2]Samuel MJ.American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults[J].J Am Geriatr Soc,2015,63(11):2227-46.
[3]O'Mahony D,O'Sullivan D,Byrne S,et al.STOPPSTART criteria for potentially inappropriate prescribing in older people:version 2[J].Age Ageing,2015,44(2)213-8.
[4]冯林林,童荣生,龙恩武,等.老年心血管病患者潜在性不适当用药及影响因素分析[J].中国医院药学杂志,2018,38(3):289-94.
[5]中国老年保健医学研究会老年合理用药分会,中华医学会老年医学分会,中国药学会.中国老年人潜在不适当用药判断标准(2017版)[J].药物不良反应杂志,2018,20(1):2-8.
[6]李影影,邢玉晶,王烨,等.Beers标准和STOPP/START标准再评价老年住院患者医嘱点评情况[J].药学与临床研究,2016,24(1):57-60
[7]段蓉,李正翔.2种标准评估老年住院患者潜在不适当用药[J].中国医院药学杂志,2017,37(19):1979-82,2000.
[8]蔡俊,聂力,张海霞,等.基于中国老年人潜在不适当用药目录评价老年住院患者不合理用药[J].中国临床药理学杂志,2018(3):375-7.
[9]国家卫生计生委合理用药专家委员会,中国药师协会.冠心病合理用药指南[J].中国医学前沿杂志(电子版),2016,8(6):19-108.
[10]Balamuthusamy S,Arora R.Hematologic adverse effects of clopidogrel[J].Am J Ther,2007,14(1):106-12.
[11]孔雪云,陈琦,吴祥,等.中西药联用相互作用研究进展[J].南京中医药大学学报,2018(1):5-11.