老年長期處方及潛在性不適當用藥之危險因子探討

The Study of Risk Factor between Potentially Inappropriate Medications and Long-Term Prescription for the Aged

李惠超(Huei-Chao Lee) ； 童俊欽(Chun-Chin Tong) ； 賴永融(Yung-Rung Lai) ； 蔡敏鈴(Min-Ling Tsai)

《臺灣臨床藥學雜誌》 22卷1期 (2014/03) Pp. 9-18

https://doi.org/10.6168/FJCP.2014.2201.02

摘要

目的：瞭解中區某醫學中心長期服藥之老年患者，潛在性不適當用藥（Potentially Inappropriate Medications，PIMs）的使用狀況並探討其相關危險因子。方法：採用回溯型橫斷性設計，收集2011年9月至12月間門診病患的就醫紀錄，將年齡大於或等於65歲且使用長期處方（處方天數≥28天）的患者納入本研究。PIM係以2012所更新之Beers Criteria（2012 Updated Beers Criteria）所列舉之「須避免使用的藥物」和「特定疾病或狀況下須避免的藥物」為依據，將研究對象分成「有PIMs」及「無PIMs」兩組進行單變項分析，然後將具有統計意義（p ＜ 0.05）之變項以多變量邏輯斯迴歸模式探討其相關危險因子。結果：在12,237名患者之中，有4,437名患者（36.2%）所服用的藥品至少有一種以上是PIM。其中最常見的PIM是zolpidem（23.7%）、dipyridamole（20.5%）與glyburide（15.7%）。在「特定疾病或狀況下應避免的PIMs」這一項中，常見失智或認知缺損的患者服用benzodiazepines類的藥物、第二代的抗精神病藥物以及抗膽鹼類藥物。多變項邏輯斯迴歸分析顯示年齡、服用藥物品項數及同時罹患精神疾病與PIM的使用有顯著關係。結論：本研究顯示長期服用藥物的老年患者，其使用PIM之盛行率偏高，本研究建議當臨床醫師面對年齡較高、服用藥物種類較多及同時罹患精神相關疾病的老年病患者，宜審慎評估其藥品的適切性，避免使用PIMs，特別是針對長期服藥的患者，藉以達到老年人用藥安全的目標。

關鍵字

潛在性不適當用藥 ； 老年病患 ； 長期處方

並列摘要

Objective: To determine the prevalence and risk factors of potentially inappropriate medications (PIMs) prescribing among elderly outpatients with long-term prescription at a medical center in central Taiwan. Methods: A retrospective cross-sectional study was conducted by using outpatient medical records between September and December of 2011, elderly patients (≥ 65 years) with long-term prescription (≥ 28 days) were included. PIMs were evaluated based on ＂drugs-to-avoid＂ and ＂drug-disease interactions＂ listed in 2012 Updated Beers Criteria. The subjects were divided into ＂with PIMs＂ and ＂without PIMs＂ groups to perform univariate analysis. The variables with statistical significance (p ＜ 0.05) were further analyzed by using multiple logistic regression to determine risk factor of PIM prescribing. Result: Among 12,237 patients in this study, 4,437 (36.2%) patients were prescribed with at least ≥ 1 PIM. zolpidem (23.7%), dipyridamole (20.5%) and glyburide (15.7%) were the most commonly prescribed PIMs. For the term, ＂drug-disease interactions＂ listed in 2012 Updated Beers Criteria, benzodiazepines, 2nd-generation antipsychotics and anticholinergics were the most common drugs being used in patients with dementia and cognitive impairment. Multivariate analysis revealed that the use of PIMs was strongly related to advanced age, higher number of medication, and co-existing mental disease. Conclusions: The prevalence of PIMs prescribing among elderly patients having long-term prescription was high. For safety of medical care for patients who have advanced age, significant number of medication prescriptions and co-existing mental disease, especially for those patients who have long-term prescriptions, we strongly suggested that physicians have to be careful in assessing the appropriateness of their drugs to prevent the elderly patients from using PIMs.

並列關鍵字

Potentially Inappropriate Medication ； Elderly Patient ； Long-Term Prescription