老人潛在性不適當用藥之型態分析及臨床應用

Patterns Analysis and Clinical Application of the Potentially Inappropriate Medication (PIM)-Taiwan Criteria

鄭育宛(Yu-Wan Cheng)

《臺灣臨床藥學雜誌》 24卷3期 (2016/09) Pp. 209-221

https://doi.org/10.6168/FJCP.2016.2403.05

摘要

目的：臺灣版潛在性不適當用藥(PIM-Taiwan)準則為一套省時又方便供醫療人員應用之準則。本研究目的在於將PIM-Taiwan導入，建立本院的潛在性不適當用藥準則並臨床運用。一、探討本院老年病人使用PIMs的情形。二、探討使用「電腦輔助開方警告系統」(computer assisted prescription alert system, CAPAS)對於院內PIM使用之影響，並推廣該系統的使用。方法：一、參考臺灣版潛在性不適當用藥(PIM-Taiwan)準則，結合本院之藥物品項，以制定本院之PIM。二、向醫師進行教育訓練，以提升對PIM-Taiwan之認知。三、評估教育訓練的介入對本院PIM使用情形之影響。四、評估CAPAS的介入對本院PIM使用情形之影響。結果：本院門診處方之PIM比率較住院為高(2.930% vs. 0.184%)，最常見為長期使用肌肉鬆弛劑(0.799%)以及長期使用長效鎮靜安眠藥品(0.780%)。CAPAS導入後，門診PIM在antihistamine(H_1 blocker)及cimetidine(H_2blocker)之下降較為顯著，有統計上的意義(H_1 blocker由總件數637件降至357件，p＜0.001；cimetidine由總件數269件降至185件，p=0.001)。結論：教育訓練對於PIM之成效有限。CAPAS在有可直接替代品項者，醫師接受度則較為高；但對於只建議短期使用之藥品方面，則醫師之接受度較低。

關鍵字

潛在性不適當用藥 ； 老年人 ； 條列式準則 ； 電腦輔助開方警告系統

並列摘要

Objectives: Potentially inappropriate medication-Taiwan, the time-efficient criteria for medical staff using. Our research aim is to develop our potentially inappropriate medication criteria and apply to our hospital. 1. to determine the population of PIM-Taiwan criteria among geriatric patients in our hospital. 2. to determine the effectiveness of the ＂computer-assisted prescribing alert system＂ (CAPAS) on PIM prescriptions for older adults in regional hospitals and to promote the utilization of the CAPAS. Method: 1. To develop PIM Criteria in our hospital. 2. To improve the knowledge of PIM-Taiwan Criteria by education to doctors. 3. Comparing the effectiveness of education on PIM incidence. 4. Comparing the effectiveness of the CAPAS on PIM incidence. Results: In our research, the PIM incidence of outpatients is higher than inpatients (2.930% vs. 0.184%). The most common PIM incidence of outpatients is long-term using muscle relaxants (0.799%) and long-term using long acting benzodiazepines (0.780%). After CAPAS, number of antihistamine (H1 blocker) and cimetidine (H2 blocker) were significant decreased in outpatients (H1 blocker: 637 to 357, p ＜ 0.001) (cimetidine: 269 to 185, p = 0.001). Conclusions: Education and training for the limited effectiveness of PIM. It is acceptable if we give the alternative drugs in CAPAS, but is difficult to change the long-term prescriptions.

並列關鍵字

Potentially Inappropriate Medication ； Aged ； Explicit Criteria ； Computer Assisted Prescription Alert System