危重症老年患者潜在不适当处方及药物不良反应风险
Potentially inappropriate prescribing andthe risk of adverse drug reactions in critically ill older adults.
作者信息
Galli Thamires B, Reis Wálleri C, Andrzejevski Vânia M
机构信息
Multiprofessional Residency Program of Cinics Hospital, Clinical Hospital of the Federal University of Paraná. Curitiba, PR ( Brazil ).
Laboratory of Clinical Services and Evidence Based Health (LASCES), Pharmacy Department, Federal University of Paraná , Curitiba, PR ( Brazil ). E-mail:
出版信息
Pharm Pract (Granada). 2016 Oct-Dec;14(4):818. doi: 10.18549/PharmPract.2016.04.818. Epub 2016 Dec 15.
BACKGROUND
Potentially inappropriate medication (PIM) use in the elderly is associated with increased risk of adverse drug reactions (ADRs), but there is limited information regarding PIM use in the intensive care unit (ICU) setting.
OBJECTIVE
The aim of the study is to describe the prevalence and factors associated with the use of PIM and the occurrence of PIM-related adverse reactions in the critically ill elderly.
METHODS
This study enrolled all critically ill older adults (60 years or more) admitted to medical or cardiovascular ICUs between January and December 2013, in a large tertiary teaching hospital. For all patients, clinical pharmacists listed the medications given during the ICU stay and data on drugs were analyzed using 2012 Beers Criteria, to identify the prevalence of PIM. For each identified PIM the medical records were analyzed to evaluate factors associated with its use. The frequency of ADRs and, the causal relationship between PIM and the ADRs identified were also evaluated through review of medical records.
RESULTS
According to 2012 Beers Criteria, 98.2% of elderly patients used at least one PIM (n=599), of which 24.8% were newly started in the ICUs. In 29.6% of PIMs, there was a clinical circumstance that justified their prescription. The number of PIMs was associated with ICU length of stay and total number of medications. There was at least one ADR identified in 17.8% of patients; more than 40% were attributed to PIM, but there was no statistical association.
CONCLUSIONS
There is a high prevalence of PIM used in acutely ill older people, but they do not seem to be the major cause of adverse drug reactions in this population. Although many PIMs had a clinical circumstance that led to their prescription during the course of ICU hospitalization, many were still present upon hospital discharge. Therefore, prescription of PIMs should be minimized to improve the safety of elderly patients.
背景
老年人使用潜在不适当药物（PIM）与药物不良反应（ADR）风险增加相关，但关于重症监护病房（ICU）环境中PIM使用的信息有限。
目的
本研究旨在描述危重症老年人中PIM的使用情况、与PIM使用相关的因素以及PIM相关不良反应的发生情况。
方法
本研究纳入了2013年1月至12月期间在一家大型三级教学医院内科或心血管内科ICU住院的所有60岁及以上危重症老年人。对于所有患者，临床药师列出了ICU住院期间使用的药物，并使用2012年Beers标准分析药物数据，以确定PIM的使用情况。对于每种确定的PIM，分析病历以评估与其使用相关的因素。还通过查阅病历评估ADR的发生频率以及PIM与所确定的ADR之间的因果关系。
结果
根据2012年Beers标准，98.2%的老年患者使用了至少一种PIM（n = 599），其中24.8%是在ICU中新开始使用的。在29.6%的PIM中，存在证明其处方合理的临床情况。PIM的数量与ICU住院时间和药物总数相关。17.8%的患者至少发生了一次ADR；超过40%归因于PIM，但无统计学关联。
结论
急性病老年人中PIM的使用率很高，但它们似乎不是该人群药物不良反应的主要原因。尽管许多PIM在ICU住院期间有导致其处方的临床情况，但出院时许多PIM仍然存在。因此，应尽量减少PIM的处方以提高老年患者的安全性。
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