護理之家住民接受不適當藥物治療之情形

Nursing Home Residents Receiving Inappropriate Medication Therapy

周樺蓁(Hua-Jen Chou) ； 譚延輝(Yen-Huei Tarn) ； 王婷瑩(Ting- Yin Wang)

《長期照護雜誌》 16卷1期 (2012/04) Pp. 49-73

https://doi.org/10.6317/LTC.201204_16(1).0004

摘要

美國與加拿大於1997年各發展出一套評估老人藥物治療適當性的評估工具，一為Beers等人於1991與1997所發展出的一套不適合老年人的藥物治療準則；另一為McLeod等人於1997年所歸納之老人不適當藥物療法。因臺灣護理之家住民之藥物治療中，尚缺乏相關研究與探討，所以以此長照機構做為本研究之位置，而以藥物治療適當性為研究目標。研究由兩位藥師執行，於2001年在五個月中完成臺灣北區五所護理之家220位住民的藥物治療評估，依據1997年版Beer's Criteria老人濳在不適當用藥準則與同年版McLeod Criteria老人不適當藥物療法做評估依據。研究結果顯示：住民平均年齡為77.7歲，有99.5%住民接受藥物治療，其中有25.0%接受至少一種不適合老年人的藥物治療，4.1%的住民正接受兩種不適合老年人的藥物治療，其中更有2.3%（5位）同時接受三種不適當藥物治療或不適當療法之治療。以Beers criteria為依據，評估發現：220位住民中就有45位接受一種不適合老年人的藥物治療，有4.1%的住民服用準則中不適當的藥物dipyridamole；2.7%服用benzodiazepam；2.3%服用ergot compounds之老人不適當用藥。依據McLeod準則評估發現，有35位接受一種不適合老年人的藥物治療，其中7位是患有心衰竭住民卻接受鈣離子通道阻斷劑來控制高血壓；5位正服用長效benzodiazepam來治療其失眠問題。本研究結果顯示，臺灣護理之家住民確實存在接受不適當藥物治療之情形；也顯示處方醫師應能接受藥師之建議，與藥師合作共同為提昇住民用藥適當性與安全性來努力。此研究證實藥師到護理之家提供藥物治療評估服務之需要性與重要性。

關鍵字

護理之家 ； 藥師 ； 住民 ； 不適當藥物治療 ； 藥物治療評估

並列摘要

Background: In 1997, US and Canadian expert panel developed two sets of criteria to determine potential inappropriate drug usage by the older person, one developed by Beers, et al in 1991 and 1997, and the other by McLeod, et al in 1997. Objective: To investigate the frequency and patterns of potentially inappropriate drug therapy on residents of nursing home (NHRs) in Taiwan. Methods: Two pharmacists conducted the drug regimen review for a duration of five months in 2001. The drug therapy of 220 residents from 5 nursing homes in north Taiwan was reviewed. Inappropriate drugs were identified from Beer's Criteria for 1997 and Canadian perspective for 1997. Results: Residents in average was 77.7 years old, 99.5% were receiving drug therapy. Tweenty-five percent of residents had at least one inappropriate drug therapy, and 4.1% of residents had two and 2.3% had three inappropriate drug therapies. Using Beers criteria, 45 out of 220 residents had inappropriate drug usage; with 4.1% residents use dipyridamole, 2.7% use benzodiapepine, and 2.3% use ergot compounds inappropriately. Using McLeod criteria, 35 cases used inappropriately, with 7 cases had prescription of calcium-channel blocker to treat hypertension for patients with a history of heart failure, and 5 cases had long-term prescription of long-half-life benzodiazepine to treat insomnia. Conclusion: The present study demonstrates that one out of four elderly of NHRs received at least one inappropriate drug therapy. The results indicate that physician needs a pharmacist to work collaboratively to identify and resolve drug therapy problems, to improve the safety and appropriateness of residents' medication therapy. The study confirms the need and importance of having pharmacist to conduct drug regimen review in the nursing home environment.

並列關鍵字

nursing home ； pharmacist ； resident ； inappropriate drug therapy ； drug regimen review