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  • 學位論文

住院老人潛在不適當用藥與其相關因素

Potentially inappropriate medications and associated factors among older patients after hospitalization

指導教授 : 羅美芳
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摘要


研究背景:老人照護是健康照護系統主要的挑戰之一,罹患共病症、多重疾病或多重慢性病除了使老人更容易處於多重用藥的風險,也容易造成潛在不適當藥品使用,不僅增加醫療照護使用,也增加健康照護需求。 研究目的:探討住院老人潛在不適當藥品使用的盛行率與其相關因素。 研究方法:本研究為縱貫式描述性相關性研究,收案時間從2013年8月28日至2015年6月1日,從502位研究對象來自臺灣北部一家醫學中心的二個內科病房,以Charlson共病症指數、簡易心智狀況問卷、多元功能評估問卷之日常生活活動能力面向、服藥遵從行為量表、2015 AGS Beers潛在不適當藥品準則等收集資料,追蹤五個時間點,分別是住院時、住院期間、出院時、出院後第一次回診及出院後三個月,以廣義估計方程式(generalized estimating equation, GEE)做統計分析。 研究結果:最後448位個案完成五個測量時間點的測量,潛在不適當藥品的五種類別中,在五個測量時間點至少有一種潛在不適當藥品的盛行率約6.1%~ 80.9%;最常出現的藥物是metoclopramide和esomeprazole;多變量羅吉斯迴歸分析顯示處方藥種類數量為潛在不適當藥品最常見的預測因子,勝算比為1.811~11.022;在潛在不適當藥品的變動因素方面,處方藥種類數量也是最常見的因素。 結論:本研究結果顯示老人住院期間潛在不適當藥品盛行率是最高的,處方藥種類數量是最顯著的預測因子。因此,醫護人員須負起責任檢視老人藥品,務必力求減少老人藥品。另外,透過加強醫護人員對於老人用藥安全教育和教導老人正確自我藥品管理,以避免老人服藥量過多,以改善老人的用藥品質。

並列摘要


Background: Elder care is one of the major challenges in healthcare. The suffering from multi-morbidities often make the older adults at risk of polypharmacy, and thus likely to cause the potentially inappropriate medication use. The use of medical resources and demand for healthcare will both increase. Objective: To understand the prevalence and associated factors of potentially inappropriate medication use among older patients after hospitalization. Methods: Subjects were recruited from two medical wards in a medical center in northern Taiwan. Data were collected from August 28, 2013 to June 1, 2015. The data were collected by the Charlson Comorbidity Index, Short Portable Mental Status Questionnaire, the first part of Chinese-version Multidimensional Functional Assessment Questionnaire, Medication Adherence and Potentially Inappropriate Medication (2015 AGS Beers criteria) on admission, during hospital stay, at discharge, and first visit at outpatient clinic and three months after discharge. The data were analyzed by generalized estimating equation (GEE). Results: In 448 subjects, data collection was completed at all five measurement time points. Among the five categories of potentially inappropriate medication (PIM), the prevalence of at least one PIM was about 6.1% to 80.9% at five measurement time points. Metoclopramide and esomeprazole were the most common drugs. Multivariate logistic regression analysis showed that the number of prescription drugs was the most common predictor, account for 1.811~11.02 of odds ratio. The number of prescription drugs was also the most common factor in the changing factors of PIM. Conclusions: The results of this study showed that the prevalence of PIM use during hospital stay is highest. The number of prescription drugs is the most significant predictor. Therefore, healthcare professionals have to take responsibility to review and reduce medications in elderly. In addition, healthcare professionals should enforce educating the elderly about medication safety, and self-medication management to avoid excessive use of medication, and improve the quality of medication use in the elderly.

參考文獻


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