老年科收治老年患者药物治疗的优化
Optimization of drug therapy in elderly individuals admitted to a geriatric unit.
作者信息
Piau Antoine, Huet Yoann, Gallini Adeline, Andre Laurine, Vellas Bruno, Nourhashemi Fati
机构信息
Gérontopôle, Centre Hospitalier Universitaire Toulouse, Toulouse, France.
UMR1027, INSERM-University of Toulouse, Toulouse, France.
出版信息
Clin Interv Aging. 2017 Oct 11;12:1691-1696. doi: 10.2147/CIA.S132309. eCollection 2017.
BACKGROUND
A substantial share of adverse drug events involves inappropriate prescribing (IP). Specialized geriatric units are supposed to pay particular attention to prescribing appropriateness and to promoting a higher prescribing quality.
OBJECTIVE
The objective of this study was to evaluate the reality of such assessment and optimization in real life (usual care) in a population of elderly individuals admitted to a geriatric unit.
METHOD
This is an observational study including all older patients admitted to an acute geriatric unit over a 6-month period. As part of usual care, the geriatrician is supposed to detect potentially inappropriate medication and potential prescribing omission using validated tools. The primary outcome was the prevalence rate of therapeutic modifications motivated by treatment optimization (stop, switch, or introduction). Multivariate logistic regression analyses were performed to identify the factors associated with therapeutic discontinuation.
RESULTS
A total of 216 patients were included. The mean age was 85.7 years. Included patients had an average of 7.2±3.3 drugs at admission and 5.8±2.7 at discharge. IP was highly prevalent in our study where about 63% of the patients had experienced at least one modification because of overuse. The most commonly discontinued medications were drugs used to treat gastroesophageal reflux disease and peptic ulcer disease and serotonin reuptake inhibitor antidepressants. The most commonly introduced medications were analgesics and warfarin. By using multivariate analysis, we found that patient age and number of drugs on admission were significantly associated with medication discontinuation during hospital stay.
CONCLUSION
In this real-life study of all patients admitted to a Geriatric Post Emergency Unit, 83% of the patients had a treatment modification during hospital stay. The most original result of our study is the clear reduction in polypharmacy during hospitalization.
背景
相当一部分药物不良事件涉及不适当处方（IP）。老年专科病房应特别关注处方的适宜性，并提高处方质量。
目的
本研究的目的是评估老年病房收治的老年人群在现实生活（常规护理）中进行此类评估和优化的实际情况。
方法
这是一项观察性研究，纳入了在6个月期间入住急性老年病房的所有老年患者。作为常规护理的一部分，老年病医生应使用经过验证的工具检测潜在的不适当用药和潜在的处方遗漏。主要结局是因治疗优化（停用、换药或启用）而进行治疗调整的发生率。进行多变量逻辑回归分析以确定与治疗中断相关的因素。
结果
共纳入216例患者。平均年龄为85.7岁。纳入患者入院时平均使用7.2±3.3种药物，出院时为5.8±2.7种。IP在我们的研究中非常普遍，约63%的患者因用药过度至少经历了一次调整。最常停用的药物是用于治疗胃食管反流病和消化性溃疡病的药物以及5-羟色胺再摄取抑制剂类抗抑郁药。最常启用的药物是镇痛药和华法林。通过多变量分析，我们发现患者年龄和入院时的用药数量与住院期间的药物停用显著相关。
结论
在这项对所有入住老年急诊后病房患者的现实生活研究中，83%的患者在住院期间进行了治疗调整。我们研究最独特的结果是住院期间多重用药明显减少。
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