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通过使用电子病历对用药情况进行多学科评估,减少患有多种药物治疗问题的老年住院患者的用药数量。

Reduction in the numbers of drugs administered to elderly in-patients with polypharmacy by a multidisciplinary review of medication using electronic medical records.

作者信息

Hayashi Yuichi, Godai Ayumi, Yamada Megumi, Yoshikura Nobuaki, Harada Naoko, Koumura Akihiro, Kimura Akio, Okayasu Shinji, Matsuno Yasuko, Kinosada Yasutomi, Itoh Yoshinori, Inuzuka Takashi

机构信息

Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan.

Department of Pharmacy, Gifu University Hospital, Gifu, Japan.

出版信息

Geriatr Gerontol Int. 2017 Apr;17(4):653-658. doi: 10.1111/ggi.12764. Epub 2016 May 2.

Abstract

AIM

Polypharmacy is a major problem for elderly patients in developed countries. We investigated whether a multidisciplinary medication review using electronic medical records could reduce the number of drugs administered to elderly patients receiving polypharmacy.

METHODS

The present study included 432 elderly patients (188 women, 244 men; 267 patients aged 65-74 years and 165 patients aged ≥75 years) who were admitted to and discharged from the Department of Neurology and Geriatrics, Gifu University Hospital, between 2004 and 2011; those who died at the hospital were excluded. The names, categories, and numbers of orally administered drugs at admission and discharge were examined retrospectively using electronic medical records. The histories of continuous oral immunotherapy use at the hospital, falls during the 2 years before hospital admission and the presence of fall risk factors were also evaluated. P-values <0.05 were considered statistically significant.

RESULTS

On average 1.14 ± 3.07 fewer types of drugs were given to patients at discharge than at admission in patients receiving polypharmacy (P < 0.001). However, the number of drugs given to patients undergoing continuous oral immunotherapy increased by 1.67 ± 3.47 (P < 0.001). The number of drugs was reduced in 33.1% of fallers, and 36.3% of non-fallers. In both fallers and non-fallers, there was a reduction in drug categories associated with falls.

CONCLUSIONS

Multidisciplinary medication review using electronic medical records could significantly reduce the numbers of drugs taken by elderly inpatients receiving polypharmacy, including drugs associated with falls, in both fallers and non-fallers Geriatr Gerontol Int 2017; 17: 653-658.

摘要

目的

在发达国家,多重用药是老年患者面临的一个主要问题。我们调查了使用电子病历进行多学科药物评估是否能减少接受多重用药的老年患者的用药数量。

方法

本研究纳入了2004年至2011年间在岐阜大学医院神经内科和老年病科住院并出院的432例老年患者(188例女性,244例男性;267例年龄在65 - 74岁之间,165例年龄≥75岁);排除在医院死亡的患者。通过电子病历回顾性检查入院和出院时口服药物的名称、类别和数量。还评估了在医院持续口服免疫治疗的病史、入院前2年的跌倒情况以及跌倒风险因素的存在情况。P值<0.05被认为具有统计学意义。

结果

接受多重用药的患者出院时平均用药种类比入院时减少1.14±3.07种(P<0.001)。然而,接受持续口服免疫治疗的患者用药数量增加了1.67±3.47种(P<0.001)。33.1%的跌倒患者和36.3%的非跌倒患者用药数量减少。在跌倒患者和非跌倒患者中,与跌倒相关的药物类别都有所减少。

结论

使用电子病历进行多学科药物评估可显著减少接受多重用药的老年住院患者的用药数量,包括跌倒患者和非跌倒患者中与跌倒相关的药物。《老年医学与老年病学国际杂志》2017年;17: 653 - 658

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