熟练护理机构中的药物使用与处方模式：对合理治疗方法的需求。

Drug utilization and prescribing patterns in a skilled nursing facility: the need for a rational approach to therapeutics.

作者信息

Segal J L, Thompson J F, Floyd R A

出版信息

J Am Geriatr Soc. 1979 Mar;27(3):117-22. doi: 10.1111/j.1532-5415.1979.tb04139.x.

DOI:10.1111/j.1532-5415.1979.tb04139.x

Abstract

A study was made of 50 patients drawn at random from a Skilled Nursing Facility (SNF) attended by seven physicians. For 59 percent of these patients, polypharmacy was practiced but no substantiating diagnoses were recorded. Approximately half of the drugs were administered pro re nata. More drugs were prescribed in potentially toxic dosages than in subtherapeutic dosages. The risk of an adverse drug reaction (ADR) was most often associated with anticholinergic agents, sedative-hypnotic drugs, and neuroleptics (thioridazine and chlorpromazine), particularly when prescribed concurrently. Risk of an ADR was highest when a drug was prescribed without recording a definite diagnostic indication. Lack of consistency by individual physicians in their approaches to the therapy of similar disease entities in comparable patients tended to support the concept of peer review in SNFs and also the need for teaching a rational approach to therapeutics in SNFs based on clinical pharmacology as applied to the elderly.

摘要

对从一家由七名医生诊治的专业护理机构（SNF）中随机抽取的50名患者进行了一项研究。在这些患者中，59%的患者采用了多药联合治疗，但未记录到确凿的诊断依据。大约一半的药物是根据病情需要使用的。与低于治疗剂量相比，使用潜在毒性剂量药物的情况更多。药物不良反应（ADR）的风险最常与抗胆碱能药物、镇静催眠药和抗精神病药物（硫利达嗪和氯丙嗪）相关，尤其是当这些药物同时使用时。在未记录明确诊断指征的情况下开具药物时，ADR的风险最高。个别医生在治疗类似疾病实体的可比患者时方法缺乏一致性，这往往支持了SNF中同行评审的概念，也支持了在SNF中基于应用于老年人的临床药理学教授合理治疗方法的必要性。