中国老年住院患者潜在不适当用药现状研究
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摘要
目的探讨中国老年住院患者潜在不适当用药(PIM)的发生率以及相关影响因素。方法系统检索中国生物医学文献服务系统、中国知网、万方数据库、维普网、PubMed和Web of Science的相关文献(截止至2017年3月)。纳入文献类型为回顾性,对象是中国老年住院患者,并且使用了潜在不适当用药的筛查工具。排除只关注一种不合理问题或只针对某种疾病老年患者的研究。数据分析采用STATA软件。结果共纳入文献26篇,潜在不适当用药的总体发生率为33.9%(95%CI:24.5%~43.2%;范围:13.3%~82.8%)。其中有20篇研究使用了Beers标准,2篇使用了STOPP/START标准,4篇联合使用了Beers标准和STOPP/START标准。相关因素包括性别、年龄、用药种类、合并疾病种类、住院天数、付费方式等;常见的不适当用药的药物种类:苯二氮艹卓类药物、心血管系统药物、抗胆碱药物、非甾体抗炎药和甲氧氯普胺。遗漏率较高的药物为抗血小板药物、他汀类药物及二甲双胍。结论中国老年住院患者潜在不适当用药的发生率仍然很高。高龄、多重用药、合并症数量及住院天数是影响老年住院患者潜在不适当用药发生的重要影响因素。
Objective To determine the prevalence of potentially inappropriate medication( PIM) in elderly hospitalized patients across China,and to identify the risk factors for PIM. Methods The SinoMed,CNKI,Wanfang database,VIP,PubMed and Web of Science database were searched systematically for relevant literatures( until March of 2017). The literatures were included if the study design was retrospective; the study participants were elderly hospitalized patients in China,and a published screening method for PIM was used. Studies that focused on specific disease or that focused on merely one inappropriate medication problem were excluded. Data analysis was performed using STATA software. Results Twenty-six documents were included,showing an estimated overall PIM prevalence of 33. 9 %( 95%CI: 24. 5% ~ 43. 2%; range 13. 3% ~ 82. 8%). Twenty of the literatures were based on the Beers criteria,2 on STOPP/START criteria,and 4 on the combination of the Beers and STOPP/START criteria. Relevant factors included gender,age,type of medication,type of disease,length of hospital stay,payment methods,etc. In drug groups the most often involved in PIM was benzodiazepine drugs,cardiovascular drugs,anticholinergic drugs,non-steroidal antiinflammatory drugs and metoclopramide. Drugs with higher rates of underuse were antiplatelet agents,statins and metformin. Conclusion PIM prevalence in Chinese elderly hospitalized patients is high. Age,multidrug use,the number of complications and the length of hospital stay are important factors affecting the potential inappropriate use of drugs in elderly hospitalized patients.
Objective To determine the prevalence of potentially inappropriate medication( PIM) in elderly hospitalized patients across China,and to identify the risk factors for PIM. Methods The SinoMed,CNKI,Wanfang database,VIP,PubMed and Web of Science database were searched systematically for relevant literatures( until March of 2017). The literatures were included if the study design was retrospective; the study participants were elderly hospitalized patients in China,and a published screening method for PIM was used. Studies that focused on specific disease or that focused on merely one inappropriate medication problem were excluded. Data analysis was performed using STATA software. Results Twenty-six documents were included,showing an estimated overall PIM prevalence of 33. 9 %( 95%CI: 24. 5% ~ 43. 2%; range 13. 3% ~ 82. 8%). Twenty of the literatures were based on the Beers criteria,2 on STOPP/START criteria,and 4 on the combination of the Beers and STOPP/START criteria. Relevant factors included gender,age,type of medication,type of disease,length of hospital stay,payment methods,etc. In drug groups the most often involved in PIM was benzodiazepine drugs,cardiovascular drugs,anticholinergic drugs,non-steroidal antiinflammatory drugs and metoclopramide. Drugs with higher rates of underuse were antiplatelet agents,statins and metformin. Conclusion PIM prevalence in Chinese elderly hospitalized patients is high. Age,multidrug use,the number of complications and the length of hospital stay are important factors affecting the potential inappropriate use of drugs in elderly hospitalized patients.
引文
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[15]舒冰,史天陆,张圣雨,等.基于Beers标准评价365例老年住院患者潜在不适当用药[J].医药导报,2017,35(3):330-335.
[16]周仑,肖志超.Beers标准评价老年住院患者潜在不适当用药[J].中国医师杂志,2016,18(10):1546-1548.
[17]陶娌娜,张四喜,曲晓宇,等.我院老年患者潜在不适当用药及相关影响因素分析[J].中国药物应用与监测,2016,11(5):293-296.
[18]万里燕,袁丽萍,魏建英,等.住院老年患者潜在不适当用药情况调查及危险因素分析[J].药物不良反应杂志,2016,18(3):170-174.
[19]边原,蔡璐璐,龙恩武,等.Beers标准2015版在住院老年患者不适当用药评价中的应用[J].中国新药与临床杂志,2016,34(10):751-758.
[20]伍晓群,徐幸民,陈超,等.基于Beers标准回顾性评价我院老年住院患者潜在不适当用药[J].北方药学,2016,12(11):161-162.
[21]代明彬.基于老年综合评估的重庆地区住院老年人多重用药横断面研究[D].重庆医科大学,2016.
[22]梁宇,韩吉,潘超慧,等.两种评价标准在老年住院病人用药合理性评价中的应用[J].药学服务与研究,2016,15(2):146-149.
[23]韩吉,梁宇,潘超慧,等.Beers标准在老年住院患者潜在性不适当用药分析中的应用[J].医药导报,2016,15(6):656-659.
[24]宋文霞,钟天文,张瑞辉,等.老年住院患者潜在不适当用药情况分析[J].现代医院,2016,15(5):698-700.
[25]李旭琴.用Beers标准评价老年住院患者潜在性不适当用药[J].上海医药,2015,36(2):21-23,26.
[26]万里燕,魏建英,袁丽萍,等.116例老年住院患者的用药分析和评价[J].中国临床药理学杂志,2015,30(3):235-237.
[27]顾艳,刘朵,钱芳,等.2012版Beers标准在老年患者不适当用药评价中的应用[J].中国药房,2015,26(5):704-706.
[28]欧阳仲毅,邱道娇.老年住院患者潜在不适当用药情况调查分析[J].现代医院,2015,14(4):115-116.
[29]李维东.老年住院患者潜在性不适当用药评价中Beers判断标准的运用分析[J].母婴世界,2015,(8):399.
[30]孙笑琳.Beers标准回顾性分析老年住院患者潜在不恰当用药[D].大连医科大学,2014.
[31]王烨,李影影,蔡郁.Beers标准回顾性评价老年住院患者存在的潜在不适当用药[J].实用药物与临床,2013,16(9):874-875.
[32]李海菊,郭春花,王媛媛.影响我院老年住院患者潜在性不适当用药因素的回顾分析[J].中国医院药学杂志,2013,33(14):1189-1192.
[33]沈杰,刘奕芳,高宁舟,等.Beers判断标准在老年住院患者潜在性不适当用药评价中的应用[J].中国药房,2010,21(6):556-558.
[34]李影影,孙艳萍,王烨,等.我院老年住院患者潜在不适当用药情况分析[J].实用药物与临床,2016,19(3):357-359.
[35]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.
[36]周海峰,沈杰,纪芳,等.Beers标准联合STOPP/START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):3212-3214.
[37]Mo L,Ding D,Pu S,et al.Patients aged 80 years or older are encountered more potentially inappropriate medication use[J].Chin Med J,2016,129(1):22-27.
[38]Mo L,Yang X,He J,et al.Evaluation of potentially inappropriate medications in older inpatients in China[J].J Am Geriatr Soc,2014,62(11):2216-2218.
[39]Lao CK,Ho SC,Chan KK,et al.Potentially inappropriate prescribing and drug-drug interactions among elderly Chinese nursing home residents in Macao[J].Int J Clin Pharm,2013,35(5):805-812.
[40]Tommelein E,Mehuys E,Petrovic M,et al.Potentially inappropriate prescribing in community-dwelling older people across Europe:a systematic literature review[J].Eur J Clin Pharmacol,2015,71(12):1415-1427.
[41]Aparasu RR,Mort JR.Inappropriate prescribing for the elderly:beers criteria-based review[J].Ann Pharmacother,2000,34(3):338-346.
[42]Hill-Taylor B,Sketris I,Hayden J,et al.Application of the STOPP/START criteria:a systematic review of the prevalence of potentially inappropriate prescribing in older adults,and evidence of clinical,humanistic and economic impact[J].J Clini Pharmacy Therapeut,2013,38(5):360-372.
[43]Guaraldo L,Cano FG,Damasceno GS,et al.Inappropriate medication use among the elderly:a systematic review of administrative databases[J].BMC Geriatr,2011,11:79.
[2]Hedna K,Hakkarainen KM,Gyllensten H,et al.Potentially inappropriate prescribing and adverse drug reactions in the elderly:a population-based study[J].Eur J Clin Pharmacol,2015,71(12):1525-1533.
[3]Lu WH,Wen YW,Chen LK,et al.Effect of polypharmacy,potentially inappropriate medications and anticholinergic burden on clinical outcomes:a retrospective cohort study[J].CMAJ,2015,187(4):E130-E137.
[4]Price SD,Holman CD,Sanfilippo FM,et al.Association between potentially inappropriate medications from the Beers criteria and the risk of unplanned hospitalization in elderly patients[J].Ann Pharmacother,2014,48(1):6-16.
[5]Cahir C,Bennett K,Teljeur C,et al.Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients[J].Br J Clin Pharmacol,2014,77(1):201-210.
[6]Price SD,Holman CD,Sanfilippo FM,et al.Association between potentially inappropriate medications from the Beers criteria and the risk of unplanned hospitalization in elderly patients[J].Ann Pharmacother,2014,48(1):6-16.
[7]Beers MH,Ouslander JG,Rollingher I,et al.Explicit criteria for determining inappropriate medication use in nursing home residents.UCLA Division of Geriatric Medicine[J].Arch Intern Med,1991,151(9):1825-1832.
[8]O'Mahony D,Gallagher P,Ryan C,et al.STOPP&STARTcriteria:a new approach to detecting potentially inappropriate prescribing in old age[J].Eur Geriatr Med,2010,1(1):45-51.
[9]Laroche ML,Charmes JP,Merle L.Potentially inappropriate medications in the elderly:a French consensus panel list[J].Eur J Clin Pharmacol,2007,63(8):725-731.
[10]Holt S,Schmiedl S,Thurmann PA.Potentially inappropriate medications in the elderly:the PRISCUS list[J].Dtsch Arztebl Int,2010,107(31-32):543-551.
[11]McLeod PJ,Huang AR,Tamblyn RM,et al.Defining inappropriate practices in prescribing for elderly people:a national consensus panel[J].CMAJ,1997,156(3):385-391.
[12]Kim DS,Heo SI,Lee SH.Development of a list of potentially inappropriate drugs for the Korean elderly using the delphi method[J].Healthc Inform Res,2010,16(4):231-252.
[13]Chang C,Yang S,Lai H,et al.Using published criteria to develop a list of potentially inappropriate medications for elderly patients in Taiwan[J].Pharmacoepidemiol Drug Safety,2012,21(12):1269-1279.
[14]Li H,Pu S,Liu Q,et al.Potentially inappropriate medications in Chinese older adults:the beers criteria compared with the screening tool of older persons'prescriptions criteria[J].Geriatr Gerontol Int,2017.
[15]舒冰,史天陆,张圣雨,等.基于Beers标准评价365例老年住院患者潜在不适当用药[J].医药导报,2017,35(3):330-335.
[16]周仑,肖志超.Beers标准评价老年住院患者潜在不适当用药[J].中国医师杂志,2016,18(10):1546-1548.
[17]陶娌娜,张四喜,曲晓宇,等.我院老年患者潜在不适当用药及相关影响因素分析[J].中国药物应用与监测,2016,11(5):293-296.
[18]万里燕,袁丽萍,魏建英,等.住院老年患者潜在不适当用药情况调查及危险因素分析[J].药物不良反应杂志,2016,18(3):170-174.
[19]边原,蔡璐璐,龙恩武,等.Beers标准2015版在住院老年患者不适当用药评价中的应用[J].中国新药与临床杂志,2016,34(10):751-758.
[20]伍晓群,徐幸民,陈超,等.基于Beers标准回顾性评价我院老年住院患者潜在不适当用药[J].北方药学,2016,12(11):161-162.
[21]代明彬.基于老年综合评估的重庆地区住院老年人多重用药横断面研究[D].重庆医科大学,2016.
[22]梁宇,韩吉,潘超慧,等.两种评价标准在老年住院病人用药合理性评价中的应用[J].药学服务与研究,2016,15(2):146-149.
[23]韩吉,梁宇,潘超慧,等.Beers标准在老年住院患者潜在性不适当用药分析中的应用[J].医药导报,2016,15(6):656-659.
[24]宋文霞,钟天文,张瑞辉,等.老年住院患者潜在不适当用药情况分析[J].现代医院,2016,15(5):698-700.
[25]李旭琴.用Beers标准评价老年住院患者潜在性不适当用药[J].上海医药,2015,36(2):21-23,26.
[26]万里燕,魏建英,袁丽萍,等.116例老年住院患者的用药分析和评价[J].中国临床药理学杂志,2015,30(3):235-237.
[27]顾艳,刘朵,钱芳,等.2012版Beers标准在老年患者不适当用药评价中的应用[J].中国药房,2015,26(5):704-706.
[28]欧阳仲毅,邱道娇.老年住院患者潜在不适当用药情况调查分析[J].现代医院,2015,14(4):115-116.
[29]李维东.老年住院患者潜在性不适当用药评价中Beers判断标准的运用分析[J].母婴世界,2015,(8):399.
[30]孙笑琳.Beers标准回顾性分析老年住院患者潜在不恰当用药[D].大连医科大学,2014.
[31]王烨,李影影,蔡郁.Beers标准回顾性评价老年住院患者存在的潜在不适当用药[J].实用药物与临床,2013,16(9):874-875.
[32]李海菊,郭春花,王媛媛.影响我院老年住院患者潜在性不适当用药因素的回顾分析[J].中国医院药学杂志,2013,33(14):1189-1192.
[33]沈杰,刘奕芳,高宁舟,等.Beers判断标准在老年住院患者潜在性不适当用药评价中的应用[J].中国药房,2010,21(6):556-558.
[34]李影影,孙艳萍,王烨,等.我院老年住院患者潜在不适当用药情况分析[J].实用药物与临床,2016,19(3):357-359.
[35]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.
[36]周海峰,沈杰,纪芳,等.Beers标准联合STOPP/START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):3212-3214.
[37]Mo L,Ding D,Pu S,et al.Patients aged 80 years or older are encountered more potentially inappropriate medication use[J].Chin Med J,2016,129(1):22-27.
[38]Mo L,Yang X,He J,et al.Evaluation of potentially inappropriate medications in older inpatients in China[J].J Am Geriatr Soc,2014,62(11):2216-2218.
[39]Lao CK,Ho SC,Chan KK,et al.Potentially inappropriate prescribing and drug-drug interactions among elderly Chinese nursing home residents in Macao[J].Int J Clin Pharm,2013,35(5):805-812.
[40]Tommelein E,Mehuys E,Petrovic M,et al.Potentially inappropriate prescribing in community-dwelling older people across Europe:a systematic literature review[J].Eur J Clin Pharmacol,2015,71(12):1415-1427.
[41]Aparasu RR,Mort JR.Inappropriate prescribing for the elderly:beers criteria-based review[J].Ann Pharmacother,2000,34(3):338-346.
[42]Hill-Taylor B,Sketris I,Hayden J,et al.Application of the STOPP/START criteria:a systematic review of the prevalence of potentially inappropriate prescribing in older adults,and evidence of clinical,humanistic and economic impact[J].J Clini Pharmacy Therapeut,2013,38(5):360-372.
[43]Guaraldo L,Cano FG,Damasceno GS,et al.Inappropriate medication use among the elderly:a systematic review of administrative databases[J].BMC Geriatr,2011,11:79.