老年慢性病門診病患之潛在性不適當處方的相關危險因子探討

Risk Factors for Potentially Inappropriate Prescribing for Ambulatory Older Patients with Chronic Diseases

李國任(Kuo-Jen Lee) ； 陳俊傑(Chun-Chieh Chen) ； 顧明祥(Ming-Hsiang Ku) ； 許凱倫(Kai-Lun Sheu) ； 陳宣志(Shiuan-Chih Chen) ； 顏啟華(Chi-Hua Yen) ； 李孟智(Meng-Chih Lee)

《台灣家庭醫學雜誌》 22卷4期 (2012/12) Pp. 187-197

https://doi.org/10.7023/TJFM.201212.0187

摘要

Objective: To identify the risk factors for potentially inappropriate prescribing for ambulatory older patients with chronic diseases.Methods: This study included 558 consecutive patients, aged ≥ 65 years with chronic diseases, who received long-term (3-month) prescriptions during their outpatient visits to family medicine clinics at a university hospital in central Taiwan between July 1 and December 31, 2009. Potentially inappropriate medication (PIM) was assessed according to the 2003 updated Beers criteria. Data regarding demographic characteristics, coexisting diseases, and ambulatory prescriptions were collected and analyzed. The clinical factors related to potentially inappropriate prescribing were determined using logistic regression.Results: The mean age of the 558 patients was 74.9 ± 6.6 years. The mean number of comorbid conditions was 5.2 ± 2.6; the mean number of drugs prescribed was 4.9 ± 2.6. PIM was identified in 107 patients (19.2%). Multivariate analysis revealed that PIM was significantly associated with the number of drugs prescribed (p＜ 0.001), advanced age (p= 0.049), and psychiatric illnesses (p= 0.010).Conclusions: Clinicians should be alert to the possibility of PIM in ambulatory older patients with chronic diseases, especially in those taking multiple medications and those who have advanced age or psychiatric illnesses.

並列摘要

Objective: To identify the risk factors for potentially inappropriate prescribing for ambulatory older patients with chronic diseases.Methods: This study included 558 consecutive patients, aged ≥ 65 years with chronic diseases, who received long-term (3-month) prescriptions during their outpatient visits to family medicine clinics at a university hospital in central Taiwan between July 1 and December 31, 2009. Potentially inappropriate medication (PIM) was assessed according to the 2003 updated Beers criteria. Data regarding demographic characteristics, coexisting diseases, and ambulatory prescriptions were collected and analyzed. The clinical factors related to potentially inappropriate prescribing were determined using logistic regression.Results: The mean age of the 558 patients was 74.9 ± 6.6 years. The mean number of comorbid conditions was 5.2 ± 2.6; the mean number of drugs prescribed was 4.9 ± 2.6. PIM was identified in 107 patients (19.2%). Multivariate analysis revealed that PIM was significantly associated with the number of drugs prescribed (p＜ 0.001), advanced age (p= 0.049), and psychiatric illnesses (p= 0.010).Conclusions: Clinicians should be alert to the possibility of PIM in ambulatory older patients with chronic diseases, especially in those taking multiple medications and those who have advanced age or psychiatric illnesses.

並列關鍵字

risk factor ； elderly ； potentially inappropriate prescribing ； ambulatory care ； chronic disease

參考文獻

Chutka, D. S.,Takahashi, P. Y.,Hoel, R. W.(2004).Inappropriate medications for elderly patients.Mayo Clin Proc.79,122-39.

Lamy, P. P.(1985).New dimensions and opportunities.Drug Intell Clin Pharm.19,399-402.

Lin, H. Y.,Liao, C. C.,Cheng, S. H.,Wang, P. C.,Hsueh, Y. S.(2008).Association of potentially inappropriate medication use with adverse outcomes in ambulatory elderly patients with chronic diseases: experience in a Taiwanese medical setting.Drugs Aging.25,49-59.

Chang, C. M.,Liu, P. Y.,Yang, Y. H.,Yang, Y. C.,Wu, C. F.,Lu, F. H.(2004).Potentially inappropriate drug prescribing among first-visit elderly outpatients in Taiwan.Pharmacotherapy.24,848-55.

Gallagher, P. F.,Barry, P. J.,Ryan, C.,Hartigan, I.,O''Mahony, D.(2008).Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria.Age Ageing.37,96-101.