影響門診老年病患潛在性不當處方的危險因子

Risk Factors of Potentially Inappropriate Prescribing in Older Outpatients

陳志銜(Chih-Hsien Chen)

指導教授 ： 魏正宗

共同指導教授 ： 陳宣志(Shiuan-Chih Chen)

中山醫學大學/醫學院/醫學研究所/碩士(2020年)

https://doi.org/10.6834/csmu202000168

摘要

前言：藥物不良反應對於老人所造成的影響無遠弗屆，因為多重用藥多重慢性病且衰弱等等，往往在老人族群產生許多嚴重的後果例如殘廢或死亡，而潛在性不當處方是藥物不良反應發生的原因之一。為預防潛在性不當處方，創建於美國的Beers Criteria最為廣泛使用。本研究欲藉此準則來評估，在門診具慢性病的老人，且長期用藥，找出潛在性不當處方及其危險因子。

方法：研究地點為臺灣中部某醫學中心，時間自2015年4月至6月共三個月，納入65歲以上年長病患，在該院門診就診，並領取慢性處方箋者。以電子病歷紀錄病患之年齡、性別、處方藥物、慢性病、並計算共病指數。接著使用2019年Beers Criteria評估患者潛在性不當處方，將病患分為有與無潛在性不當處方兩組，檢定兩組病患之差異性，再以羅吉斯迴歸進行多變項分析找出潛在性不當處方之危險因子。

結果：共16360位病患納入研究，年齡平均為75.9 ± 7.7歲；平均慢箋數為4.5 ± 2.4 個；共病診斷數為4.3 ± 2.0；Charlson’s comorbidity index平均為1.0± 1.1。有潛在性不當處方之病患共7634位(46.7%)。最常見的潛在性不當處方條目為Benzodiazepines，共2777位 (17.0%)。最後進行羅吉斯迴歸分析，顯現每位病患處方數>4種（勝算比= 3.9；95%信賴區間= 3.6-4.1；p< 0.001）、身心科疾病（勝算比=2.6；95%信賴區間= 2.4-2.8；p < 0.001）、消化道系統疾病（勝算比= 1.3；95%信賴區間= 1.2-1.4；p< 0.001）、Charlson共病指數>1分（勝算比= 1.2；95%信賴區間= 1.1-1.3；p< 0.001）有關。

結論：針對門診慢性病年長者，潛在性不當處方盛行率接近一半，且對於多重用藥、嚴重疾病、以及消化道和身心科疾病的病患更加要小心謹慎，開立藥物時要預防潛在性不當處方產生。

關鍵字

老年人 ； 潛在不適當處方 ； Beers criteria ； 慢性病

並列摘要

Background: The misprescription, overprescription, or underprescription for older patients is a significant public health issue. Potentially inappropriate medications (PIM) in older adults has been reported to be high in many articles. PIM might increase the risk of adverse drug events, disability, hospitalization, and even death. Our aim is to investigate the risk factors of PIM in older outpatients in a single medical center.

Method: From April 2015 to June 2015, we collect elderly patients over 60 years old, who received chronic illness refill prescription in outpatient clinics at a medical center in central Taiwan. By using electronic medical records, we record the patient's age, gender, prescription, chronic diseases, and calculate the Charlson ’s comorbidity index. 2019 Beers Criteria was applied to evaluate the patient’s PIM. Patient was divided into two groups, which is “PIM group” and “Non-PIM group.” Variables was tested by univariate analysis. Logistic regression was used for multivariate analysis of potential risk factors of PIM.

Results: A total of 16,360 patients were included in the study, with an average age of 75.9 ± 7.7 years. The average number of chronic illness refill prescription was 4.5 ± 2.4, and the number of comorbidities diagnosed was 4.3 ± 2.0. Average of Charlson ’s comorbidity index was 1.0 ± 1.1. There were 7,643 patients (46.7%) with potentially inappropriate prescriptions. The most common PIMs were benzodiazepines (17.0%). Logistic regression analysis was performed, and PIM risk was related to number of medication >4 (odds ratio, OR = 3.9; 95% confidence interval, CI = 3.6-4.1; p <0.001), psychiatric diseases (OR = 2.6; 95% CI = 2.4-2.8; p <0.001), gastrointestinal diseases (OR = 1.3; 95% CI = 1.2-1.4; p <0.001), and Charlson's comorbidity index >1 (OR = 1.2; 95% CI = 1.1-1.3; p <0.001).

Conclusions: For elderly with chronic diseases, the prevalence of PIM is common and related to multiple factors. Clinicians need to pay more attention and be careful while prescribing medication.

並列關鍵字

elderly ； potentially inappropriate prescribing ； Beers criteria ； chronic disease

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