居家照護老年人潛在性不適當用藥評估

Evaluation of Potentially Inappropriate Medications Among Elderly Home Care Residents

黃馨瑩(Hsin-Ying Huang)

指導教授 ： 林双金

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2014年)

https://doi.org/10.6832/KMU.2014.00015

摘要

背景
老年人因罹患多種慢性病，需長期使用多種藥品，因而有多重用藥 (polypharmacy) 的嚴重情形發生。另由於自然之老化及各大小健康問題，造成身心功能的衰退，故較年輕人有較多的用藥不良反應、交互作用、不適當用藥 (使用沒有效果的藥品或所使用之藥品風險過高) 或不必要用藥 (使用無適應症或無效的藥品、重複用藥) 發生。然而，鮮為人知的是潛在性不適當用藥和接受居家照護居民特性之間的關聯性。

目的
本研究目的為分析南部某醫學中心附設居家護理所，首次接受居家照護老年人之住民特性、潛在性不適當用藥盛行率及潛在危險因子，藉以提升用藥安全。

方法
本研究設計為回溯性橫斷面研究，研究期間由2012年1月1日至2012年12月31日止。藉由收集該醫院附設居家護理所首次接受居家照護老年人之處方，以台灣潛在性不適當用藥準則（PIM-Taiwan Criteria）來評估潛在性不適當用藥。資料來源：研究醫院門診掛號及用藥批價檔。納入條件： (1)年齡≧65歲者；(2)至少使用一項研究醫院之藥品。並收集資料包含個案基本資料、疾病診斷代碼及藥品相關資料等。將收集到的資料利用電腦套裝軟體（SPSS 18.0版、SAS 9.3版及Microsoft Office Excel 2007）進行資料轉換及統計分析。

結果
納入居家護理所個案489人，其中291人(59.5%)為女性。平均年齡為80.3±6.9歲。總處方藥品品項共3,472項。結果顯示447人(91.4%)至少有3個疾病診斷代碼；364人 (74.4 %)服用至少五種藥品；112人(22.9%)為過度多重用藥（同時服用十種以上）；平均每人使用7.1 ± 3.9項藥品，最多有逹27項藥品同時在使用。個案服用至少一種潛在性不適當用藥有149人(30.5%)；接受至少兩種以上不適當用藥治療有60人(12.3%)。在處方特性中，服用藥品品項總數愈多、使用苯二氮平類、抗膽鹼或抗癲癇等這三類藥品，與其處方適當性具有顯著之相關性。

結論
研究中發現約有三分之一首次接受居家照護老年人，至少接受一種潛在性不適當用藥的治療，尤其在服用藥品品項總數愈多、使用苯二氮平類、抗膽鹼或抗癲癇等這三類藥品者風險較高。所以，建議應宣導此資訊於相關醫療人員，且利用電腦醫囑警示系統來預防潛在性不適當用藥的發生。未來希望經由藥師介入評估來提升居家照護老年人之用藥安全。

關鍵字

居家照護 ； 潛在性不適當用藥

並列摘要

Background
Older adults use higher numbers of medications compared with younger age groups, primarily because of increased numbers of co-morbid conditions and greater numbers of physicians involved in their care, putting them at higher risk of polypharmacy. Medication management is of utmost significance in older adults because of changes in body composition, physical function, social environment, and limiting finances with increasing age. Many medications may result in an adverse drug reaction, interactions, inappropriate prescribing (under- or overuse of medications, drug duplication). However, little is known about the associations between potentially inappropriate medications (PIMs) and home care residents ' characteristics.
Objective
The aims of this study were to determine the characteristics, prevalence, and potentially risk factors of PIMs use among elderly residents first-time receiving home care in the Medical Center in South Taiwan and in order to improve the safety of medicines.
Method
From January 2012 to December 2012, the study population comprised all residents who were 65 years or older and consumed at least one medication. All data of this retrospective cross-sectional study were collected from electronic medical charts and medication administration records. Data collection parameters included basic demographic information, diagnoses, and medications, etc. The screening tool of Potentially Inappropriate Medication-Taiwan Criteria (PIM-Taiwan Criteria) was utilized for investigating the prevalence of PIMs use. All analyses were conducted using the SPSS version 18.0, SAS version 9.3 and Microsoft Excel 2007.
Results
489 older residents were included in the study, of which 291(59.5%) were females. The mean age of eligible residents was 80.3 ± 6.9 years. A total of 3,472 medications were prescribed for the 489 residents. Among them, 447(91.4%) residents of the study had at least three diagnoses and 364 (74.4 %) residents consumed at least five medications. 112(22.9%) residents took more than 10 medications or more (excessive polypharmacy). They consumed an average of 7.1 ± 3.9 different medications and the overall range was 1-27 medications. PIMs identified by the PIM-Taiwan Criteria. 149 (30.5%) residents used at least one PIM and 60(12.3%) residents consumed two or more PIMs. Higher number of medications, use anticonvulsant drugs, use anticholinergics drugs, and use benzodiazepine(BZD) drugs were identified as predictors for PIM-Taiwan Criteria.
Conclusion
PIM is a significant problem among elderly residents first-time receiving home care in the Medical Center in South Taiwan. The findings of nearly one-third of the residents were exposed to PIMs need further attention, particularly on those that have higher number of medications, use anticonvulsant drugs, anticholinergics drugs, and BZD drugs. The public and physicians should be educated, and a computerized drug surveillance system might be needed to avoid PIM prescriptions to the elderly home care patients. Further studies should be conducted to evaluate the clinical outcomes of pharmacist-led interventions for elderly residents receiving home care and improve the safety of medicines.

並列關鍵字

Home care ； Potentially Inappropriate Medications

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