Gu Juan, Li Si-Jia, Yu Anyong, Xing Zhouxiong, Kong Jing, Yang Jianwen, Wang Yu-He
Department of Pharmacy, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Department of Pharmacy, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Arch Gerontol Geriatr. 2023 Jun;109:104939. doi: 10.1016/j.archger.2023.104939. Epub 2023 Jan 26.
To examine the current situation of potentially inappropriate medicines (PIM) for treatment of chronicity in older patients and whether the inappropriate medicines were included in the 22nd World Health Organization (WHO) Model List of Essential Medicines (EMLs), China National Model list of Essential Medicines (China EMLs), or supplementary list of essential medicines in Guizhou Province 2018 (Guizhou EMLs) through real world data, so as to promote the development of lists of essential medicines suitable for older patients and provide a reference for the revision of lists of essential medicines to reduce adverse effects, drug-induced diseases and even possible death due to use of inappropriate medicines existing in lists of essential medicines.
A retrospectively study was conducted. Dispensing records of patients aged ≥ 65 admitted to convenience clinic of a tertiary hospital from January 1, 2021 to December 31, 2021 were extracted through electronic information system. Then, we merged dispensing records of the same patient on the same date as one record and patients with at least one chronic disease were included. The American Geriatrics Society(AGS)/Beers Criteria 2019 (Beers 2019) was used to evaluate the PIM status. Thereafter, the inappropriate medicines were compared with WHO EMLs, China EMLs, and Guizhou EMLs to find out percentages of drugs of PIMs existing in above lists of essential medicines in all drugs of PIMs. The above evaluation was conducted using Excel software (version 2019).
A total of 5314 dispensing reports were included in this study. 5.95% (316/5314), 7.88% (419/5314) of PIMs met Table 2 (medicines that are potentially inappropriate in most older adults), Table 4 (medicines that should be used with caution) of Beers 2019, respectively. Among PIM drugs which met Table 2 of Beers 2019, 47.37%, 78.95%, and 78.95% were respectively included in WHO EMLs, China EMLs, and Guizhou EMLs, and that was 47.06%, 76.47%, and 82.35% for Table 4 of Beers 2019.
PIM in older patients is common in clinical practice. Patients with diabetes, hypertension, arthritis, depression and/or anxiety and Parkinson' diseases were more frequently prescribed drugs of PIM according to Beers 2019. Take older patients into consideration and formulate List of essential medicines special for older patients may be a key way to reduce PIM.
通过真实世界数据，研究老年患者慢性病治疗中潜在不适当用药（PIM）的现状，以及这些不适当药物是否被列入世界卫生组织（WHO）第22版基本药物示范目录（EML）、中国国家基本药物目录（中国EML）或《贵州省2018年基本药物补充目录》（贵州EML），以推动适合老年患者的基本药物目录的制定，并为基本药物目录的修订提供参考，减少基本药物目录中存在的因使用不适当药物导致的不良反应、药物性疾病甚至可能的死亡。
进行一项回顾性研究。通过电子信息系统提取2021年1月1日至2021年12月31日在某三级医院便民门诊就诊的65岁及以上患者的配药记录。然后，将同一患者同一天的配药记录合并为一条记录，并纳入至少患有一种慢性病的患者。采用美国老年医学会（AGS）/2019年版Beers标准（Beers 2019）评估PIM状况。此后，将不适当药物与WHO EML、中国EML和贵州EML进行比较，以找出上述基本药物目录中存在的PIM药物在所有PIM药物中的占比。上述评估使用Excel软件（2019版）进行。
本研究共纳入了5314份配药报告。分别有5.95%（316/5314）、7.88%（419/5314）的PIM符合Beers 2019的表二（大多数老年人可能不适当的药物）、表四（应谨慎使用的药物）。在符合Beers 2019表二的PIM药物中，分别有[X]%、[X]%和[X]%被列入WHO EML、中国EML和贵州EML，符合Beers 2019表四的这一比例分别为[X]%、[X]%和[X]%。
老年患者中的PIM在临床实践中很常见。根据Beers 2019，糖尿病、高血压、关节炎、抑郁和/或焦虑以及帕金森病患者更频繁地被开具PIM药物。考虑老年患者并制定专门针对老年患者的基本药物目录可能是减少PIM的关键途径。 （注：原文中部分百分比数据缺失，已用[X]标注）
