探討老年患者使用長期處方而發生潛在性不適當用藥之相關因子

Factors affecting the use of potentially inappropriate medications among older patients having long-term prescription

李惠超(Huei-Chao Lee)

指導教授 ： 曾淑玲

中山醫學大學/醫學院/醫學研究所/碩士(2013年)

https://doi.org/10.6834/CSMU.2013.00092

摘要

研究目的：
本研究以2012年美國老年醫學會(The American Geriatrics Society, AGS)所修訂的Beers Criteria為準則，了解中山醫學大學附設醫院老年患者使用長期處方服用潛在性不適當用藥(Potentially Inappropriate Medications, PIMs)的狀況，並探討其相關危險因子。
研究方法：
本研究為回溯型橫斷性(retrospective cross-sectional study)，利用中山醫學大學附設醫院「藥局作業系統」整理2011年10至12月間病患的就醫紀錄，僅將年齡大於或等於65歲、使用長期處方(處方天數≥ 28天)的患者納入本研究中。所使用藥物將以2012 AGS Beers Criteria為依據，判斷是否存在有PIM；將研究對象分成「有PIM」及「無PIM」兩組進行分析。單變項分析後將具有統計意義之變項，進而以多變量邏輯斯回歸模式探討其相關危險因子。
研究結果：
符合收入條件的門診老年病患合計12,237名，有4,437名患者服用的藥品中至少有一種以上的PIM，占總患者數的36.2%；病患使用的「老年族群應避免使用的PIM或類別」，最常見的藥物Zolpidem、Dipyridamole、Glyburide。而病患服用「老年族群在特定疾病或狀況下，應避免使用的PIM或類別」最常見藥物為失智或認知缺損的患者服用Benzodiazepine (BZD)類藥物、第二代的抗精神病用藥及抗膽鹼類藥物。多變項邏輯斯迴歸分析顯示年齡(、服用藥物數及罹患精神疾病與PIM的發生有顯著相關。
結論與建議：
本研究顯示長期服用藥物的老年病患使用潛在性不適當藥物盛行率為36.2 %。可能之相關因素為年齡、服用較多藥物種類數及罹患精神相關疾病。常見的PIM為Zolpidem、Dipyridamole與Glyburide等；在失智或認知缺損的患者常使用BZD類、第二代的抗精神病類與抗膽鹼類用藥。因此，當臨床醫師處方到具危險因子的老年病患時，宜審慎評估其藥品的使用。

關鍵字

老年病患 ； 長期使用藥物 ； 2012 AGS Beers Criteria ； 不適當用藥

並列摘要

Objective:
This study is using 2012 AGS Beers Criteria to examine the prevalence and risk factors associated with using potentially inappropriate medications (PIMs) among older patients having long-term prescription at a medical center in central Taiwan.
Methods:
A retrospective cross-sectional study was conducted by using medical records between October and December 2011, in which 12,237 older patients (≥ 65 years) who having long-term prescription (≥ 28 days) were included. PIMs were evaluated according to 2012 AGS Beers Criteria. The subjects were divided into “with PIM” and “without PIM” groups. We performed univariate analysis by Chi-square analysis for categorical variables, and Student’s t test for continuous variables. The variables with statistical significance (p<0.05) were further followed by multiple logistic regression to find out the related risk factors.
Results:
4,437 (36.2%) patients received at least one PIM. Zolpidem (23.7%), Dipyridamole (20.5%) and Glyburide (15.7%) were the most commonly prescribed PIMs. The use of benzodiazepines, 2nd-generation antipsychotics and anticholinergics in patients with dementia and cognitive impairment was also common. Multivariate analysis revealed that PIM was significantly associated with advanced age, the number of medications prescribed, and mental disease.
Conclusions:
There was a high prevalence of prescribing PIMs among older patients having long-term prescription. When dealing with patients of advanced age, the considerable number of medications prescribed and mental disease, physicians should carefully assess the appropriateness of their drugs to improve care of older patients by reducing their exposure to PIMs.

並列關鍵字

Older patient ； Long-term prescriptions ； 2012 AGS Beers Criteria ； Potentially inappropriate medications

參考文獻

2.黃盈翔, 盧豐華. 老年人之用藥原則. 台灣醫學 2003;7:385-95.

33.李國任, 陳俊傑, 顧明祥, et al. 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. 臺灣家庭醫學雜誌 2012;22:187-97.

52.陳苓怡, 郭美娟, 黃尚志, 蔡哲嘉, 陳鴻鈞. 臨床評估腎臟功能方法之優缺點. 內科學誌 2012;23:34-41.

57.陳姿吟, 李季黛, 周明岳, 薛光傑, 杜明勳. 簡介老人用藥準則之工具. 家庭醫學與基層醫療 2011;26:370-6.

1.Resnick NM, Marcantonio ER. How should clinical care of the aged differ? Lancet 1997;350:1157-8.