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本文引用的文献

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The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis.临床用药决策支持系统对患者结局和医生实践表现的影响:系统评价和荟萃分析。
BMC Med Inform Decis Mak. 2021 Mar 10;21(1):98. doi: 10.1186/s12911-020-01376-8.
2
The utility of a computerised clinical decision support system intervention in home medicines review: A mixed-methods process evaluation.计算机化临床决策支持系统干预在家庭用药审查中的效用:混合方法过程评估。
Res Social Adm Pharm. 2021 Apr;17(4):715-722. doi: 10.1016/j.sapharm.2020.06.010. Epub 2020 Jun 10.
3
[Atropinic burden and anticholinergic drugs: Interest and application in clinical practice in the elderly].[阿托品负荷与抗胆碱能药物:在老年临床实践中的意义及应用]
Therapie. 2021 Nov-Dec;76(6):665-673. doi: 10.1016/j.therap.2018.02.010. Epub 2018 Mar 7.
4
Inadequate drug prescribing: comparison of inappropriate drug rates at the end of a geriatric short-stay service with three prescribing tools.药物处方不当:使用三种处方工具对老年短期住院服务结束时的不适当用药率进行比较。
Geriatr Psychol Neuropsychiatr Vieil. 2017 Dec 1;15(4):364-368. doi: 10.1684/pnv.2017.0683.
5
[Inappropriate prescription and administration of medications in 10 nursing homes in Alsace, France].[法国阿尔萨斯地区10家养老院中药物的不恰当处方与用药情况]
Rev Epidemiol Sante Publique. 2016 Apr;64(2):95-101. doi: 10.1016/j.respe.2015.12.016. Epub 2016 Mar 2.
6
American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.美国老年医学会2015年更新的《老年人潜在不适当用药的Beers标准》
J Am Geriatr Soc. 2015 Nov;63(11):2227-46. doi: 10.1111/jgs.13702. Epub 2015 Oct 8.
7
[Clinical audit on drug prescriptions for elderly patients hospitalized in a unit of psychiatry].[某精神科病房老年住院患者用药处方的临床审计]
Encephale. 2016 Feb;42(1):14-23. doi: 10.1016/j.encep.2015.06.005. Epub 2015 Sep 5.
8
STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.老年人潜在不适当处方的STOPP/START标准:第2版
Age Ageing. 2015 Mar;44(2):213-8. doi: 10.1093/ageing/afu145. Epub 2014 Oct 16.
9
A meta-synthesis of potentially inappropriate prescribing in older patients.老年患者潜在不适当处方的元综合分析。
Drugs Aging. 2014 Aug;31(8):631-8. doi: 10.1007/s40266-014-0190-4.
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[Orthostatic hypotension: what to think of it and what to do?].[直立性低血压:如何看待及如何应对?]
Rev Med Suisse. 2013 Sep 11;9(397):1618-21.

内科住院老年患者处方评估

Assessment of Prescriptions in Elderly Patients Hospitalized in Medicine Departments.

作者信息

Giroux Audrey, Prudent Christelle, Jouanny Pierre, Muller Géraldine, Devilliers Hervé, Vadot Lucie

机构信息

Pharmacy Department, Dijon University Hospital Center, 21000 Dijon, France.

Geriatric Internal Medicine Department, Dijon University Hospital Center, 21000 Dijon, France.

出版信息

J Clin Med. 2021 Nov 16;10(22):5343. doi: 10.3390/jcm10225343.

DOI:10.3390/jcm10225343
PMID:34830625
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8621875/
Abstract

Drug-related iatrogenesis is an important issue in the elderly population, and preventing iatrogenic accidents helps to reduce hospitalizations. Our study's objective was to evaluate prescriptions in the geriatric population of our establishment. The study conducted is a targeted clinical audit. Ten criteria were tested on the hospital prescriptions of people over 75 years old in 11 medical departments, before and after improvement actions. The non-compliance threshold was set at 10% of prescriptions for each criterion. In each phase, 165 patients were included. Four criteria were non-compliant (NC) in the first phase: the presence of Potentially Inappropriate Medications for the Elderly (PIMs) (NC = 57.6%), the adaptation of the medication to renal clearance (NC = 24.9%), the presence of illogical combination (NC = 9.7%), and the total anti-cholinergic score of the prescription (NC = 12.1%). After the implementation of improvement actions, the number of non-compliant criteria decreased between the two phases, from four to two. We obtained a significant improvement for three of the four criteria found to be non-compliant in the first phase. The criterion adaptation to renal function is close to compliance (NC = 10.1%) and the PIMs criterion remained non-compliant after reassessment (NC = 32.1%). Vigilance must be ongoing in order to limit drug iatrogeny, particularly in frail elderly patients.

摘要

药物相关的医源性疾病在老年人群中是一个重要问题,预防医源性事故有助于减少住院率。我们研究的目的是评估我院老年人群的处方情况。所开展的研究是一项针对性的临床审计。在采取改进措施前后,对11个医疗科室中75岁以上患者的医院处方测试了10项标准。每项标准的不合规阈值设定为处方的10%。在每个阶段,纳入了165名患者。在第一阶段,有四项标准不合规(NC):存在老年人潜在不适当用药(PIMs)(NC = 57.6%)、药物剂量根据肾脏清除率调整(NC = 24.9%)、存在不合理用药组合(NC = 9.7%)以及处方的总抗胆碱能评分(NC = 12.1%)。在实施改进措施后,两个阶段之间不合规标准的数量从四项减少到两项。我们发现第一阶段中四项不合规标准中的三项有显著改善。根据肾功能调整剂量这一标准接近合规(NC = 10.1%),而重新评估后PIMs标准仍不合规(NC = 32.1%)。必须持续保持警惕,以限制药物医源性疾病,特别是在体弱的老年患者中。