老年慢性病患者用药偏差及相关因素研究

目的：调查老年慢性病患者用药偏差现状并分析可能的原因及影响因素。方法：提取山东、天津两地四家医院2017年11月1日至2017年12月31日60岁及以上老年患者病历，采用调查问卷的方式分析用药偏差发生的基本情况，并采用Logistic模型分析用药偏差影响因素。结果：研究最终纳入400例患者，用药偏差发生率为59.0%；发生用药偏差的类型主要为治疗不充分（36.0%）和用法用量不适宜（30.2%）；二级医院就诊的患者用药偏差发生率高于三级医院就诊的患者（74.0%vs 44.0%）；糖尿病（61.0%）、冠状动脉疾病（59.5%）、高血压（58.7%）患者用药偏差发生率较高；消化道和代谢方面药物（36.8%）和心血管系统药物（32.5%）用药偏差发生率较高；Logistic回归结果显示，患多种慢病、出院带药品种多的老年慢性病患者发生用药偏差的风险更大。结论：样本医院老年慢性病患者用药偏差发生率较高，不同级别医院、不同慢病患者与使用药物发生用药偏差存在不均衡性。

Investigation on medication discrepancies and related factors in elderly patients with chronic diseases

OBJECTIVE To investigate the status quo and influencing factors of medication discrepancies in elderly patients with chronic diseases and analyze the possible causes and influencing factors.METHODS The medical records of elderly patients aged 60 years and above from November 1, 2017 to December 31, 2017 in four hospitals in Shandong and Tianjin were extracted. The basic situation of medication discrepancy was analyzed by questionnaire, and the influencing factors of medication discrepancy were analyzed by Logistic model.RESULTS The 400 elderly patients were included in this study. A total of 59.0% patients experienced medication discrepancies. The most common types were omitted medication (36.0%) and incorrect usage or dosage (30.2%). The incidence of medication discrepancies in patients from the secondary hospitals were more common than patients from the tertiary hospitals (74.0% vs 44.0%). Patients with diabetes (61%), coronary artery disease (59.5%) and hypertension (58.7%) were the most frequent chronic diseases involved in medication discrepancies. The most common drug classes involved in medication discrepancies were gastrointestinal (36.8%) and cardiovascular medications (32.5%). The Logistic regression analysis revealed that patients with higher number of comorbidities, higher number of prescribed medications were more likely associated with medication discrepancy.CONCLUSION Medication discrepancies are common in elderly patients with chronic diseases in sample hospitals and there is an imbalance in medication deviation between hospitals of different levels, patients with different chronic diseases and drugs used.