Hanlon J T, Schmader K E, Koronkowski M J, Weinberger M, Landsman P B, Samsa G P, Lewis I K
Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA.
J Am Geriatr Soc. 1997 Aug;45(8):945-8. doi: 10.1111/j.1532-5415.1997.tb02964.x.
To describe the prevalence, types, and consequences of adverse drug events (ADEs) in older outpatients with polypharmacy.
A cohort study.
General Medicine Clinic at the Durham Veterans Affairs Medical Center.
A total of 167 high risk (taking > or = 5 scheduled medications) ambulatory older veterans who participated in a year long health service intervention trial.
Potential ADEs were identified by asking patients during closeout interviews whether, in the past year, they had experienced any side effects, unwanted reactions, or other problems from any medication. All reported medications and corresponding adverse experiences were assessed for plausibility by a research clinical pharmacist using two standard pharmacological textbooks and categorized by predictability, therapeutic class, and organ system.
Eighty self-reported ADEs involving 72 medications taken by 58 (35%) of 167 patients were textbook confirmed. Seventy-six of 80 (95%) ADEs were classified as Type A (predictable) reactions. Cardiovascular (33.3%) and central nervous system (27.8%) medication classes were most commonly implicated. Gastrointestinal (30%) and central nervous system (28.8%) ADE symptoms were common. Sixty-three percent of patients with ADEs required physician contacts, 10% emergency room visits, and 11% hospitalization. Twenty percent of medications implicated with ADEs required dosage adjustments, and 48% of ADE-related medications were discontinued. No significant differences (P > .05) were observed when ADE reporters (n = 58) and nonreporters (n = 109) were compared.
Predictable ADEs are common in high risk older outpatients, resulting in considerable medication modification and substantial healthcare utilization.
描述老年多病门诊患者药物不良事件（ADEs）的发生率、类型及后果。
队列研究。
达勒姆退伍军人事务医疗中心综合内科门诊。
共有167名高危（服用≥5种常规药物）的老年门诊退伍军人参与了一项为期一年的健康服务干预试验。
在结束访谈时询问患者过去一年是否因任何药物出现过副作用、不良反应或其他问题，以此确定潜在的ADEs。研究临床药剂师使用两本标准药理学教科书对所有报告的药物及相应不良事件进行合理性评估，并按可预测性、治疗类别和器官系统进行分类。
167名患者中有58名（35%）报告了80起自我认定的ADEs，涉及72种药物，经教科书证实。80起ADEs中有76起（95%）被归类为A型（可预测）反应。最常涉及的药物类别是心血管类（33.3%）和中枢神经系统类（27.8%）。胃肠道（30%）和中枢神经系统（28.8%）的ADE症状较为常见。63%发生ADEs的患者需要联系医生，10%需急诊就诊，11%需住院治疗。20%与ADEs相关的药物需要调整剂量，48%与ADEs相关的药物被停用。比较报告ADEs的患者（n = 58）和未报告的患者（n = 109）时，未观察到显著差异（P > .05）。
可预测的ADEs在高危老年门诊患者中很常见，会导致大量药物调整和大量医疗资源利用。
