基于STOPP标准的神经内科门诊老年患者潜在不适当用药分析
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摘要
目的采用老年人潜在不适当处方筛查工具(Screening Tool of Older Persons’ Prescriptions,STOPP)标准评估老年神经内科门诊患者的潜在不适当用药(potentially inappropriate medication,PIM)情况。方法回顾性分析2016年1月—3月就诊于浙江大学医学院附属第二医院神经内科门诊的5 185例年龄≥65岁的老年患者,采用STOPP标准评估这些患者用药PIM的发生率。采用多因素Logistic回归分析寻找PIM的危险因素。结果基于STOPP标准发现,5 185例老年患者中,有290例(5.59%)患者存在至少1次PIM,共发生了446例PIM。其中,发生最普遍的前3位分别是①长期(>1月)使用长效苯二氮?类药物和有长效代谢产物的苯二氮?类药物;②阿司匹林用于没有冠状动脉、脑及周围血管栓塞病史的患者,或者用于消化性溃疡史患者不加用H_2受体阻断剂或PPI,或者阿司匹林剂量≥150mg·d~(-1),或者治疗不是脑血管疾病导致的头晕;③长期(>1月)使用抗神经病药物作为催眠药物或者用于帕金森病患者。通过多因素逻辑回归分析发现,患者用药数(OR=1.145,95%CI:1.109～1.182)以及诊断数(OR=1.208,95%CI:1.111～1.313)与PIM发生率显著相关。结论神经内科门诊老年患者PIM的发生与他们使用的药品数以及诊断数是显著相关的,对于用药品种多,诊断多的患者需要重点关注。
OBJECTIVE To assess the prevalence of using potentially inappropriate medication(PIM) in older neurology outpatients using the Screening Tool of Older Persons' Prescriptions(STOPP) criteria. METHODS A retrospective survey was adapted to include 5 185 neurology outpatients aged ≥65 years from Second Affiliated Hospital, Zhejiang University, School of Medicine, from January 2016 to March 2016. PIM were defined using the STOPP criteria. A multivariate logistic regression study was used to identify the risk factors for PIM. RESULTS Based on STOPP criteria, 446 PIM were found to affect 290 patients. Of the 5 185 participants, 290(5.59%) were prescribed at least one PIM. The three most common prescribed PIM were as follows: ①long-acting benzodiazepines; ②aspirin with a history of peptic ulcer disease without a histamine H_2 receptor antagonist or proton pump inhibitor; ③long-term neuroleptics in Parkinson Disease patients. Based on multivariate logistic regression analysis, the number of prescription medications(OR=1.145; 95%CI: 1.109?1.182) and the number of diagnoses(OR=1.208; 95%CI: 1.111?1.313) were significantly associated with PIM. CONCLUSION The numbers of medications and diagnoses were closely associated with PIM in older neurology outpatients. More attention should be paid to elderly patients with multiple medications and diagnoses.
OBJECTIVE To assess the prevalence of using potentially inappropriate medication(PIM) in older neurology outpatients using the Screening Tool of Older Persons' Prescriptions(STOPP) criteria. METHODS A retrospective survey was adapted to include 5 185 neurology outpatients aged ≥65 years from Second Affiliated Hospital, Zhejiang University, School of Medicine, from January 2016 to March 2016. PIM were defined using the STOPP criteria. A multivariate logistic regression study was used to identify the risk factors for PIM. RESULTS Based on STOPP criteria, 446 PIM were found to affect 290 patients. Of the 5 185 participants, 290(5.59%) were prescribed at least one PIM. The three most common prescribed PIM were as follows: ①long-acting benzodiazepines; ②aspirin with a history of peptic ulcer disease without a histamine H_2 receptor antagonist or proton pump inhibitor; ③long-term neuroleptics in Parkinson Disease patients. Based on multivariate logistic regression analysis, the number of prescription medications(OR=1.145; 95%CI: 1.109?1.182) and the number of diagnoses(OR=1.208; 95%CI: 1.111?1.313) were significantly associated with PIM. CONCLUSION The numbers of medications and diagnoses were closely associated with PIM in older neurology outpatients. More attention should be paid to elderly patients with multiple medications and diagnoses.
引文
[1]National Bureau of Statistics of China.Statistical Communique of the People’s Republic of China on the 2016National Economic and Social Development[R/OL].http://www.stats.gov.cn/english/PressRelease/201702/t20170228_1467503.html.
[2]Center for Health Statistics and Information.An Analysis Report of National Health Services Survey in China,2013[R/OL].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2016/10/20161026163512679.pdf.
[3]SHEN J,LIU Y F,GAO N Z,et al.Evaluation of potentially inappropriate medication among hospitalized older patients by Beers criteria[J].China Pharm(中国药房),2010,21(6):556-558.
[4]WANG M H,WU Y Z,ZHU Z E.Potential drug-drug interactions in elderly patients in the internal medicine ward[J].Chin J Mod Appl Pharm(中国现代应用药学),2016,33(3):359-364.
[5]GNJIDIC D,JOHNELL K.Clinical implications from drug-drug and drug-disease interactions in older people[J].Clin Exp Pharmacol Physiol,2013,40(5):320-325.
[6]HAMILTON H,GALLAGHER P,RYAN C,et al.Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients[J].Arch Intern Med,2011,171(11):1013-1019.
[7]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.
[8]FICK D,COOPER J,WADE W,et al.Updating the Beers criteria for potentially inappropriate medication use in older adults results of a US consensus panel of experts[J].Arch Intern Med,2003,163(22):2716-2724.
[9]DAVIDOFF A J,MILLER G E,SARPONG E M,et al.Prevalence of potentially inappropriate medication use in older adults using the 2012 Beers criteria[J].J Am Geriatrics Soc,2015,63(3):486-500.
[10]GALLAGHER P,O’MAHONY D.STOPP(Screening Tool of Older Persons’potentially inappropriate Prescriptions):application to acutely ill elderly patients and comparison with Beers’criteria[J].Age Ageing,2008,37(6):673-679.
[11]GALLAGHER P,RYAN C,BYRNE S,et al.STOPP(Screening Tool of Older Person’s Prescriptions)and START(Screening Tool to Alert doctors to Right Treatment).Consensus validation[J].Int J Clin Pharmacol Ther,2008,46(2):72-83.
[12]O’MAHONY D,O'SULLIVAN D,BYRNE S,et al.STOPP/START criteria for potentially inappropriate prescribing in older people:version 2[J].Age Ageing,2014,44(2):213-218.
[13]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,2017,17(11):1951-1958.
[14]NICIEZA-GARCIA M L,JIMENO-DEMUTH F J,MANSOG,et al.Inappropriate prescribing in elderly outpatients taking multiple medications.Are the STOPP criteria useful?[J].Int JClin Pharmacol Ther,2016,54(03):172-176.
[15]LIM Y J,KIM H Y,CHOJ J,et al.Potentially Inappropriate medications by Beers criteria in older outpatients:prevalence and risk factors[J].Korean J Fam Med,2016,37(6):329.
[16]KIMURA T,OGURA F,YAMAMOTO K,et al.Potentially inappropriate medications in elderly Japanese patients:effects of pharmacists’assessment and intervention based on Screening Tool of Older Persons’Potentially Inappropriate Prescriptions criteria ver.2.[J].J Clin Pharm Ther,2017,42(2):209-214.
[2]Center for Health Statistics and Information.An Analysis Report of National Health Services Survey in China,2013[R/OL].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2016/10/20161026163512679.pdf.
[3]SHEN J,LIU Y F,GAO N Z,et al.Evaluation of potentially inappropriate medication among hospitalized older patients by Beers criteria[J].China Pharm(中国药房),2010,21(6):556-558.
[4]WANG M H,WU Y Z,ZHU Z E.Potential drug-drug interactions in elderly patients in the internal medicine ward[J].Chin J Mod Appl Pharm(中国现代应用药学),2016,33(3):359-364.
[5]GNJIDIC D,JOHNELL K.Clinical implications from drug-drug and drug-disease interactions in older people[J].Clin Exp Pharmacol Physiol,2013,40(5):320-325.
[6]HAMILTON H,GALLAGHER P,RYAN C,et al.Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients[J].Arch Intern Med,2011,171(11):1013-1019.
[7]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.
[8]FICK D,COOPER J,WADE W,et al.Updating the Beers criteria for potentially inappropriate medication use in older adults results of a US consensus panel of experts[J].Arch Intern Med,2003,163(22):2716-2724.
[9]DAVIDOFF A J,MILLER G E,SARPONG E M,et al.Prevalence of potentially inappropriate medication use in older adults using the 2012 Beers criteria[J].J Am Geriatrics Soc,2015,63(3):486-500.
[10]GALLAGHER P,O’MAHONY D.STOPP(Screening Tool of Older Persons’potentially inappropriate Prescriptions):application to acutely ill elderly patients and comparison with Beers’criteria[J].Age Ageing,2008,37(6):673-679.
[11]GALLAGHER P,RYAN C,BYRNE S,et al.STOPP(Screening Tool of Older Person’s Prescriptions)and START(Screening Tool to Alert doctors to Right Treatment).Consensus validation[J].Int J Clin Pharmacol Ther,2008,46(2):72-83.
[12]O’MAHONY D,O'SULLIVAN D,BYRNE S,et al.STOPP/START criteria for potentially inappropriate prescribing in older people:version 2[J].Age Ageing,2014,44(2):213-218.
[13]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,2017,17(11):1951-1958.
[14]NICIEZA-GARCIA M L,JIMENO-DEMUTH F J,MANSOG,et al.Inappropriate prescribing in elderly outpatients taking multiple medications.Are the STOPP criteria useful?[J].Int JClin Pharmacol Ther,2016,54(03):172-176.
[15]LIM Y J,KIM H Y,CHOJ J,et al.Potentially Inappropriate medications by Beers criteria in older outpatients:prevalence and risk factors[J].Korean J Fam Med,2016,37(6):329.
[16]KIMURA T,OGURA F,YAMAMOTO K,et al.Potentially inappropriate medications in elderly Japanese patients:effects of pharmacists’assessment and intervention based on Screening Tool of Older Persons’Potentially Inappropriate Prescriptions criteria ver.2.[J].J Clin Pharm Ther,2017,42(2):209-214.