Santoni Fannie, Antoine Valéry, di Castri Alberto, Viala Maurice, Geronimi-Robelin Laetitia, LeGuillou Cédric, de Taddeo Christine, Bastide Sophie, Jeandel Claude, de Wazieres Benoit
Service de médecine interne gériatrique, CHU Carémeau, Nîmes, France.
Bespim, CHU Carémeau, Nîmes, France.
Geriatr Psychol Neuropsychiatr Vieil. 2017 Jun 1;15(2):153-162. doi: 10.1684/pnv.2017.0671.
Polypharmacy, potentially inappropriate prescriptions and inadequate coordination between prescribers are among main factors explaining the occurrence of adverse drug events in elderly patients. Prospective and descriptive study of medication prescriptions for elderly patients during a continuous period of health-care: entry in an acute geriatric unit (T1), at discharge (T2) and two months after hospitalization (T3). A global iatrogenic risk was defined: presence of poly-pharmacy and/or PPI (Laroche criteria) and/or absence of quality indicators for prescription according to the French health authority. For the 79 patients (mean age 87), mean number of medication decreased from 7.33 (T1) to 6 (T2) (p=0.0018) and 6 (T3). Number of quality indicators for prescription improved from 6.67 (T1) to 6.92 (T2) (p=0.001) then decreased to 6.84 (T3). Number of PPI decreased from 1.16 to 0.42 between T1 and T2 (p=0.001) then increased to 0.59 at T3. The global iatrogenic risk indicator fluctuated from 80% (T1) to 64% (T2) and 75% (T3). Selected interventions were developed to prevent adverse drug events during hospitalization and ambulatory follow-up. If geriatric intervention can enhance quality of prescription, iatrogenic risk remains frequent all along health-care follow-up. A local study of prescriptions can be a first step to develop an adequate program for adverse drug events prevention.
多重用药、潜在不适当处方以及开方者之间缺乏充分协调是老年患者发生药物不良事件的主要因素。对老年患者在连续一段医疗保健期间的用药处方进行前瞻性描述性研究：进入急性老年病科时（T1）、出院时（T2）以及住院后两个月（T3）。定义了一种总体医源性风险：存在多重用药和/或潜在不适当处方（拉罗什标准）和/或根据法国卫生当局的规定缺乏处方质量指标。对于79名患者（平均年龄87岁），平均用药数量从7.33（T1）降至6（T2）（p = 0.0018），T3时为6。处方质量指标数量从6.67（T1）提高到6.92（T2）（p = 0.001），然后降至6.84（T3）。T1和T2之间潜在不适当处方数量从1.16降至0.42（p = 0.001），T3时增至0.59。总体医源性风险指标从80%（T1）波动至64%（T2）和75%（T3）。制定了选定的干预措施以预防住院期间和门诊随访期间的药物不良事件。如果老年病干预能够提高处方质量，那么在整个医疗保健随访过程中医源性风险仍然很常见。对处方进行局部研究可以是制定适当的药物不良事件预防计划的第一步。
