某院门急诊老年患者潜在不适当用药的评价分析

目的 使用Beers标准(2019版)对某院门急诊老年患者潜在不适当用药(PIM)情况进行系统分析,为促进患者用药安全提供依据.方法 回顾性抽取某院2020年第四季度门急诊处方,对65岁及以上的老年患者用药情况进行统计分析,以Beers标准(2019版)为评判依据,评价老年患者PIM情况.结果 共收集该院2020年第四...     

老年人潜在不适当用药Beers标准2019修订版解读

Beers标准是一个用于避免老年人潜在不适当用药的实用工具。该标准于1991年由老年医学专家Beers首次公布,自2011年开始由美国老年医学会(American geriatrics society,AGS)管理,每3年更新一次,最近AGS更新发布了2019版。Beers标准的主要目的在于指导医务工作者为老年患者选择适当药物,确保老年人用药安全。     

基于Beers标准(2019版)评价河北省多种慢性病共存老年心力衰竭住院患者的潜在不适当用药

目的 基于Beers标准(2019版)对河北地区多种慢性病共存老年心力衰竭(简称心衰)住院患者的潜在不适当用药(PIM)进行调查,并结合各疾病专科诊疗指南进行深入分析,探讨其相关危险因素,为促进多种慢性病共存老年人群临床合理用药提供参考。方法 2022年1月随机从河北省4家医疗机构信息系统中各抽取50例老年心衰住院患者的电子病历资料。根据纳入与排除标准,最终纳入135例符合标准的患者。基于Beers标准(2019版)对老年心衰住院患者的PIM情况进行评估,结合疾病诊疗指南深入用药分析评价,给出用药建议。采用多因素Logistic回归分析老年心衰住院患者发生PIM的影响因素。结果 不同年龄、罹患疾病种类的老年心衰住院患者PIM发生率比较,差异均无统计学意义(P>0.05);不同性别、用药种类、肾小球滤过率(GFR)的老年心衰住院患者PIM发生率比较,差异均有统计学意义(P<0.05)。按PIM发生频率高低排序前3位依次为利尿剂、螺内酯、苯二氮类镇静催眠药物。38例患者存在53例次PIM,排名前3的药物分别为苯二氮类镇静催眠药物、地高辛和抗精神病药物。24例患者存在26例次PI...     

安徽省老年人潜在不适当用药的风险调查及相关因素分析

目的了解老年人潜在不适当用药（PIM）带来的健康风险,为有效实施老年人用药安全的风险管理与保护老年人的健康权益提供依据。方法采用分级抽样方法选择了安徽省8个代表性的城乡社区,用基于 Beers 准则设计的问卷进行实地调查。调查获得的数据用 Epidata 和 SPSS 软件进行分析。结果抽样地区的老年人群总体不适当使用药物种类较多,频率较高,排在前10名的药物不适当使用频率均高于30％。城乡地区老年人在治疗感冒、抗细菌性感染、防治高血压与冠心病等药物的不适当使用频率的差异在统计学上有意义（P ＜0．05）,其中农村社区老年人群在治疗感冒药物方面的不适当使用频率比城市社区低,而其他药物的不适当使用频率明显比城市社区高。在同一社区,受教育程度与家庭收入较高的老年人用药安全风险意识往往强些,其 PIM流行率也明显低于受教育程度与家庭收入较低的老年人。结论安徽省部分地区老年人不适当的用药情况较为普遍,老年人用药安全风险意识较低。     

基于Beers标准和STOPP/START标准评价老年消化道疾病的潜在不适当用药

目的了解老年患者消化道疾病的潜在不恰当用药,为老年患者消化道疾病的临床用药提供借鉴。方法提取在老年医学科住院的285例患者病历,依据Beers标准和STOPP/START标准,对消化道疾病存在的潜在不恰当用药情况进行筛查。结果依据Beers标准,285例患者病历中有61例(21%)存在潜在不适当用药,共计85项。按照STOPP标准,285例患者病历中23例(8%)筛查出潜在不适当用药,共计39项;按照START标准,筛查出16例(6%)患者病历存在处方遗漏情况,共计16项; 50例(18%)患者存在Beers标准和STOPP/START标准未包括的潜在不适当用药(PIMs);影响老年消化道疾病患者发生PIMs的因素包括:年龄、疾病种类、住院时间、用药种类、日常生活能力量表评分(ADL)。结论老年患者消化道疾病存在潜在不恰当用药,易导致PIMs的影响因素较多,使用Beers标准和STOPP/START标准对老年消化道疾病患者的用药进行评估,能有效降低PIMs发生,提高老年消化道疾病诊疗的医疗质量。     

潜在不适当用药对老年人不良健康结局影响的系统评价

目的 明确潜在不适当用药对老年人不良健康结局的影响,为预防不良健康结局提供依据.方法 检索PubMed、The Cochrane Library、Web of Science、EMBASE、中国生物医学文献数据库、中国知网和万方数据库,搜集建库至2019年2月关于潜在不适当用药对老年人不良健康结局影响的文献,采用RevMan 5.3软件进行分析.结果 共纳入33项队列研究,结果显示潜在不适当用药对药物不良反应、再次入院率有影响(RR=1.69,95%CI=1.28~2.23,P<0.001;RR=1.47,95%CI=1.30~ 1.66,P<0.001),但不会增加死亡率(RR=1.02,95%CI=0.98~ 1.07,P=0.310).结论 潜在不适当用药是老年人发生药物不良反应/药物不良事件和再次入院的危险因素,增加了社会经济负担,耗费了医疗资源.     

老年住院患者潜在不恰当用药的影响因素分析

目的研究老年住院患者潜在不恰当用药发生率及影响因素。方法随机抽取符合纳入标准的陕西省人民医院住院患者699例,使用2015版Beers标准评价病例,采用频率统计方法、χ2检验中的独立性检验及多因素Logistic回归分析进行统计描述及推断。结果 (1)老年住院患者潜在不恰当用药发生率为79.5%。(2)联合用药数量多、医保报销比例高的老年住院患者更容易发生潜在不恰当用药,内科病房相对外科病房的老年住院患者更容易发生潜在不恰当用药。结论老年住院患者潜在不恰当用药发生率高,联合用药数量、医保类型、出院科室为其影响因素。     

社区老年人安全用药情况调查与建议

目的 调查社区老年人用药情况,给予安全用药指导,避免出现用药相关问题,以最大程度保障老年人用药安全.方法 自制问卷调查表,对372位60～82岁社区老年人用药情况、用药知识和用药行为等方面进行调查与分析.结果 社区老年人用药种类繁多,正在使用药物的人数占85.2%,人均用药5种.大多数老年人缺乏安全用药知识,其中掌握较差的内容依次为:多种药物合用易发生不良反应(42.5%)、应明确诊断后用药(40.9%)、密切观察用药后病情变化和反应(34.1%),用药后出现异常反应及时停药就诊(22.8%)及老年人用药特点(6.2%).在用药行为方面,老年人服药依从性较差,表现为经常改变服药时间、间隔或漏服(63.4%)、合并使用处方药与非处方药(60.5%)、停药太快或擅自停药(56.7%)、无医生诊断和处方自行在药房购药(53.5%).结论 社区老年人缺乏安全用药知识和存在不正确用药行为,易导致药物不良反应发生和影响药物治疗效果,提示社区护理人员应加强老年人安全用药知识与用药行为的教育与指导.     

社区老年人用药安全现状及对策研究

我国已步入老龄化社会.老年人口的快速增加,特别是80岁以上的高龄老人和失能老人的快速增长,对老年人的生活照料、康复护理、医疗保健等需求日益凸显.目前,我国社区老年人口增长速度很快,许多老年人患有多种慢性疾病,需要长期服用多种药物.老年人的合理用药和用药安全是社区老年人健康教育和卫生服务的重要内容之一,也是当今老年社会保障的热点问题之一[1].由于各种原因造成老年人不适当用药,或药物对老年人产生不良反应,存在着许多用药的安全隐患,既给老年人的健康造成潜在的危害,同时也造成有限的医疗资源流失[2-3].针对这一问题,为老年人开展用药安全的工作提供理论依据,以期提高社区老年人的用药安全性,现报道如下.     

Inappropriate prescribing in older residents of Australian care homes

What is known and objective: The incidence of inappropriate prescribing is higher amongst the older age group than the younger population. Inappropriate prescribing potentially leads to drug‐related problems such as adverse drug reactions. We aimed to determine the prevalence of inappropriate prescribing in residents of Tasmanian (Australia) residential care homes using Beers and McLeod criteria. Methods: Patient demographics, medical conditions and medications were collected from medical records. The patients who fulfilled either Beers or McLeod criteria were identified and the characteristics of these patients were then compared. Results: Data for 2345 residents were collected between 2006 and 2007. There were 1027 (43·8%) patients prescribed at least one inappropriate medication. Beers criteria identified more patients (828 patients, 35·3%) as being prescribed inappropriate medication compared with McLeod criteria (438 patients, 18·7%). Patients taking psychotropic medication/s, more than six medications or diagnosed with five or more medical conditions were more likely to be prescribed an inappropriate medication (P < 0·001). The most frequently identified inappropriate medications included benzodiazepines, amitriptyline, oxybutynin and non‐steroidal anti‐inflammatory drugs. What is new and conclusion: Inappropriate prescribing, as defined by either Beers criteria or McLeod criteria, is relatively common in Australian nursing homes. The prevalence of inappropriate prescribing, and factors influencing it, are consistent with other countries. Both Beers and McLeod criteria are a general guide to prescribing, and do not substitute for professional judgment.     

Medication Discrepancy and Potentially Inappropriate Medication in Older Chinese-American Home-Care Patients After Hospital Discharge

BackgroundStudies of potential medication problems among older adults have focused on English-speaking populations in a single health care setting or a single potential medication problem. No previous studies investigated potential inappropriate medications (PIMs) and medication discrepancies (MDs) among older Chinese Americans during care transitions from hospital discharge to home care.ObjectiveThe aims of this study were to examine, in older Chinese Americans, the prevalence of both PIMs and MDs; the relationship between PIMs and MDs; and the patient and hospitalization characteristics associated with them during care transitions from hospital discharge to home care.MethodsThis cross-sectional study was conducted with a sample of older Chinese Americans from a large certified nonprofit home-care agency in New York City from June 2010 to July 2011. PIMs were identified by using 2002 diagnosis-independent Beers criteria. MDs were identified by comparing the differences between hospital discharge medication order and home-care admission medication order. Prevalence of PIMs and MDs and their relationship was determined. Logistic regression examined the relationship between hospitalization and patient characteristics with PIMs and MDs.ResultsThe sample consisted of 82 older Chinese-American home-care patients. Twenty (24.3%) study participants were prescribed at least one PIM at hospital discharge. Fifty-one (67.1%) study participants experienced at least one MD. A positive correlation was found between the occurrence of PIMs and MDs (r = 0.22; P = 0.05). Number of medications was the only significant factor associated with both PIMs and MDs. In addition, older age and more hospitalization days were associated with PIMs.ConclusionsThe evident prevalence of PIMs and MDs supports the practice of evaluating the appropriateness of medications while reconciling inconsistencies in medication regimens. The number of medications was the only factor associated with both PIMs and MDs, underscoring the need to address polypharmacy as a multifaceted threat to patient health.     

Practical Use of the American Geriatric Society Beers Criteria® 2019 Update

The American Geriatric Society Beers Criteria® 2019 update provides guidance for safe and quality prescribing for older adults. Medications were added to the list and medications were deleted from the list since the update in 2015. This article uses a case study to exemplify how the Beers Criteria may be used in practice. The Beers Criteria® are not meant to be hard and fast rules but rather assists health care providers in recognizing potentially inappropriate medications for older adults and assessing the best prescribing practices. Nurse practitioners should consider incorporating the American Geriatric Society Beers Criteria® in their pharmacologic prescribing resources.