基层医院临床药师对心血管慢病患者实施入院药物重整的实践与分析

目的 通过临床药师对心血管慢病患者实施入院药物重整实践,分析临床药师药物重整服务对于心血管慢病人群在用药安全性和依从性等方面发挥的作用。方法 对某基层医院2022年1月至12月入院的心血管慢病患者进行药物重整,对24小时内用药医嘱的连续性及合理性进行审核,将医嘱中存在的问题及干预结果进行汇总和分析。结果 共有154例患者纳入研究,年龄23～84岁,平均年龄(65.2±11.5)岁;患者合并病种1～10种,平均(4.6±1.9)种;患者入院前服用西药1～11种,平均(3.9±2.4)种;在药物重整服务中共发现41个药物相关问题,分析原因药物选择占58.5%,剂量选择占36.6%,患者相关占4.9%;24小时内医嘱需要干预的患者占21.43%,需要干预的医嘱条数占3.2%,临床药师干预成功率为95.12%。结论 心血管患者中老年患者居多,合并疾病多、服药种类多,临床药师对心血管慢病患者实施入院药物重整,发现潜在药物相关问题,协助医师优化了治疗方案,提高了心血管慢病患者用药安全性和依从性,可以作为基层医院的常规工作开展。     

老年人不宜使用的药物

不适当药物的使用是导致老年人发病和死亡的一个重要原因.文章介绍了国际上广泛应用的两个老年人用药指南.Beers标准介绍了48种药物在老年人中应避免使用或限量使用和20种老年人特定病症不宜使用药物的理由及危害等级.加拿大标准介绍了38种药物在老年人中应避免使用,并对老年人不适当处方行为提出了替代治疗方案.推广两个指南的应...     

老年人不宜使用的药物

不适当药物的使用是导致老年人发病和死亡的一个重要原因。文章介绍了国际上广泛应用的两个老年人用药指南。Beers标准介绍了48种药物在老年人中应避免使用或限量使用和20种老年人特定病症不宜使用药物的理由及危害等级。加拿大标准介绍了38种药物在老年人中应避免使用,并对老年人不适当处方行为提出了替代治疗方案。推广两个指南的应用,将有利于改善老年人不适当药物应用的局面,使老年人少受药物不良反应的危害。     

末期老年住院患者多重用药及药物重整调查

目的分析末期老年住院患者临床特点及用药情况。方法采用老年人1年内死亡率预测指数评分,入选2015年1月至2017年12月北京协和医院老年医学科病房≥70岁的末期老年患者99例,收集并分析患者慢性病、老年综合征特点、入院带药种数、经药物重整后出院带药种数及患心脑血管疾病的末期老年患者用药情况。应用SPSS 21.0统计软件对数据进行分析。根据数据类型,组间比较采用t检验或McNemar配对χ~2检验。结果 99例患者1年内死亡率预测指数7～16(9.8±2.3)分。患者慢性病占比前3位依次为恶性肿瘤(76.8%)、高血压(56.6%)及冠心病(39.4%),前3位老年综合征依次为多重用药(出院带药≥5种,72.7%)、营养不良或营养风险(72. 7%)及便秘(45. 4%)。入院时患者用药数(4. 7±3. 7)种,药物重整后出院带药数显著增加,为(7. 4±3. 9)种,其中维生素、通便药、镇痛药、呼吸系统药、抑酸药、铁剂及抗抑郁药等对症药物的使用率显著增加,对因药物降压药使用率显著降低,差异均有统计学意义(P0. 05)。患有心脑血管疾病的48例患者出院时52.1%(25/48)使用抗血小板药,66. 7%(32/48)使用他汀类药物。23例因出血风险较高,或存在活动性出血未使用抗血小板药; 16例患者主要因失能、他汀类药物相关不良反应风险高、新发肌痛或新发肝功能异常未使用他汀类药物。结论末期老年患者经药物重整后对症治疗药物使用率增加,对因药物使用率下降,心血管疾病用药策略需结合患者自身情况合理制定。     

老年人合理用药指导

如何能在老年慢性病中恰当用药，并使药物发挥最佳效能。笔者认为应做到以下几点。     

潜在不适当用药与衰弱老年人不良结局的相关分析

目的评估潜在不适当用药(PIM)与衰弱老年人不良结局的相关性。方法入选2015年1月至2017年12月首都医科大学附属复兴医院综合科老年衰弱患者226例进行研究,根据美国老年医学会Beers标准(2015版)将患者纳入PIM组(n=169)和非PIM组(n=57),比较2组患者日常生活能力(ADL)、认知功能和查尔森共病指数(CCI)等老年综合评估情况。随访截止2018年12月,不良结局终点事件包括非计划再入院和全因死亡。应用SPSS 23.0统计软件对数据进行分析。Cox回归分析PIM与衰弱患者临床不良结局的相关性,Kaplan-Meier生存曲线分析2组患者生存率的差异。结果 PIM检出率为74.8%(169/226),PIM药物中雷贝拉唑占52.7%(89/169),艾司唑仑占42.6%(72/169)。PIM组较非PIM组患者口服药种类和疾病数明显增多,差异有统计学意义(P0.05)。Cox回归分析结果表明PIM(HR=1.425,95%CI 1.005～2.021;P=0.047)、年龄(HR=1.047,95%CI 1.013～1.083;P=0.007)和CCI(HR=1.095,95%CI 1.014～1.182;P=0.021)与不良结局相关。Kaplan-Meier分析表明PIM组与非PIM组衰弱老年患者生存率差异有统计学意义(P=0.033)。结论 PIM与衰弱老年人不良结局相关,应加强衰弱筛查及临床合理用药。     

老年人潜在不适当用药的现状及应对策略

不合理用药在老年人中常见而不可避免, 从而导致药物不良反应发生、再住院率及死亡率增加, 以及加重医疗经济负担。减少不合理用药势在必行, 规范药物处方已成为临床医师及药师面临的新的挑战。准确的不合理用药检测方法、实用有效的合理用药方案、不合理用药的干预措施, 都是指导临床合理用药的关键。本文从不合理用药的危险因素、现状以及应对策略等方面对国内外研究现状进行综述, 以期减少老年人不合理用药、降低用药风险、改善老年人用药环境。     

老年人药物不良反应分析及对策

随着人们生活及卫生保健的改善，人的平均寿命显著延长，许多疾病也就随着年龄的增大而增长，人老病多，特别是慢性疾病。老年人同时使用多种药物治疗的情况很常见，通常都用3—4种药物，甚至10种以上。这样多种药物同时使用，势必使药物不良反应（ADR）和药物中毒的可能性增加，对老年人的安全和健康构成了很大威胁，随差我国老龄人口不断增加，     

老年人的药物与药物相互作用

老年人的药物与药物相互作用上海铁道医学院药理教研究（２０００７０）王革新，许士凯王革新讲师老年人因常患１种以上的慢性病，病情复杂，往往同时使用多种药物治疗，所以很容易引起药物与药物的相互作用（ｄｒｕｇ－ｄｒｕｇｉｎｔｅｒａｃｔｉｏｎｓ）。据报道，７５...     

老年人药物不良反应

老年人药物不良反应上海第二医科大学药理教研室（２０００２５）孙琛孙琛教授１老年人药物不良反应发生率药物不良反应（ａｄｖｅｒｓｅｄｒｕｇｒｅａｃｔｉｏｎｓ，ＡＤＲ）是指在常用量情况下，由于药物或药物相互作用而发生意外的、与防治目的无关的不利或有害反应。...     

Preoperative medication use and its association with postoperative length of hospital stay in surgical oncology patients receiving comprehensive geriatric assessment

Aim

The present study aimed to investigate whether preoperative medication use is associated with postoperative length of hospital stay in older adults undergoing cancer surgery.

Methods

Patients aged ≥65 years who were scheduled for cancer surgery and presented for preoperative comprehensive geriatric assessment were included in the present study. Cognitive function evaluation and preoperative medication review were carried out, as well as baseline characteristics of participants collected from electronic medical records. The primary efficacy variable was the postoperative length of stay (LOS) in hospital.

Results

A total of 475 cancer patients were included for the analysis. Baseline characteristics of participants including older age, lower body mass index (BMI) and male sex were associated with longer postoperative stay. Among the clinical variables, cancer type, number of medications, potentially inappropriate medication (PIM) and delirium‐inducing medication were found as statistically significant factors for postoperative LOS. In multivariate analysis, variables independently associated with postoperative LOS were cancer type, PIM use, BMI, and the number of medications after controlling for age, BMI, sex, cancer type, the number of medications, PIM, and delirium‐inducing medication. In subgroup analysis of gastrointestinal cancer, multiple linear regression analysis showed that PIM use and BMI were significantly associated with LOS after adjustment for age, sex, and number of medication.

Conclusions

The present study supports the impact of medication use on postoperative LOS in geriatric oncology patients. The results add a further aspect to medication optimization in older patients undergoing cancer surgery. Geriatr Gerontol Int 2018; 18: 12–19 .     

The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people

OBJECTIVES: To determine whether a medication review by a specialized team would promote regimen changes in elders taking multiple medications and to measure the effect of regimen changes on monthly cost and functioning. DESIGN: A randomized-controlled trial. SETTING: Health center ambulatory clinic. PARTICIPANTS: Community-dwelling older adults taking five or more medications were assessed at baseline and 6 weeks. A medication-change intervention group of 57 elders was compared with a control group of 76 elder adults. INTERVENTION: The primary intervention was a comprehensive review and recommended modification of a patient's medication regimen. Changes were endorsed by each patient's primary physician and discussed with each patient. MEASUREMENTS: Measures were the Timed Manual Performance Test, Physical Performance Test, Functional Reach Assessment, subtests from the Wechsler Adult Intelligence Scale, a modified Randt Memory Test, the Center for Epidemiological Studies-Depression Scale, the Self-Rating Anxiety Scale, and the Rand 36-item Health Survey 1.0. Comorbidity was determined using the International Classification of Diseases, Ninth Revision, Clinical Modification. Medication usage was determined using brown bag review. RESULTS: Intervention subjects decreased their medications by an average of 1.5 drugs. No differences in functioning were observed between groups. Intervention subjects saved an average $26.92 per month in wholesale medication costs; control subjects saved $6.75 per month (P<.006). CONCLUSION: Although the intervention significantly reduced the medications taken and monthly cost, most patients were resistant to reducing medications to the recommended level. Further study is needed to understand patient resistance to reducing adverse polypharmacy and to devise better strategies for addressing this important problem in geriatric health. Greater focus on prescriber behavior is recommended.     

Validation of dizziness as a possible geriatric syndrome

OBJECTIVE: While dizziness has traditionally been considered solely as a symptom of discrete diseases, recent findings from population-based studies of older persons suggest that it may often be a geriatric syndrome with multiple predisposing risk factors, representing impairments in diverse systems. To validate these findings, we identified predisposing risk factors for dizziness in a clinic-based population. DESIGN: Cross-sectional study. SETTING: Geriatric assessment center. PARTICIPANTS: 262 consecutive, eligible patients. MEASUREMENTS: Medical history and physical examination data were ascertained and characteristics of patients with and without a report of dizziness were compared. RESULTS: Seven factors were independently associated with a report of dizziness, namely depressive symptoms, cataracts, abnormal balance or gait, postural hypotension, diabetes, past myocardial infarction, and the use of three or more medications. Of patients with none of these risk factors, none reported dizziness. This proportion rose from 6% among patients with one factor, to 12%, 26%, and 51% among patients with two, three, and four or more factors, respectively. CONCLUSIONS: The finding of similar factors associated with dizziness in previous community-based cohorts and the present clinic-based cohort supports the possibility of a multifactorial etiology of dizziness in many older persons. A multifactorial intervention targeting the factors identified in these studies may be effective at reducing the frequency or severity of dizziness in older patients.     

老年综合评估及多学科团队服务在老年共病干预中的应用

目的 探讨住院老年患者通过老年综合评估(CGA)及多学科团队服务(GITS)进行多维度诊疗,为老年患者提供科学、合理的个性化诊疗模式,有效改善共病诊疗效果及生活质量。方法 选取年龄≥60岁的老年科共病患者,分为观察组和对照组。使用自主开发的“老年综合评估软件V2.0”对210例老年患者入院7天内进行老年综合评估,随后观察组根据评估结果给予共病、老年综合征、心理、认知及生活方式等全面综合干预,对照组仅给予共病干预。干预3个月后行第2次老年综合评估,比较观察组与对照组共病及生活质量改善情况。结果 (1)观察组比对照组血压、血糖控制效果更好(P<0.05),观察组比对照组慢性心衰急性加重、慢性阻塞性肺疾病急性加重发生人数减少(P<0.05)。(2)老年综合征及生活质量：观察组比对照组Barthel指数得分及MMSE得分显著提高(P<0.05),观察组比对照组营养、抑郁、焦虑、跌倒、衰弱均有显著改善(P<0.05),因促眠药物的应用观察组与对照组睡眠障碍均有改善,改善程度无显著差异(P>0.05)。结论 老年患者住院期间进行老年综合评估并结合多学科团队服务,可以及...     

两种不同养老机构老年综合征调查分析

目的探讨不同养老机构老年综合征的发生情况。 方法2019年6月选取入住驻京某部队干休所及北京某高级养老机构的老年人各40例进行调查,均在该养老机构中居住超过3年,采用老年综合评估方法进行筛查比较,包括一般情况、生活方式、健康情况、疾病与服药情况、老年综合征/老年问题情况、功能状况、生活质量。组间计量资料的比较采用t检验分析,计数资料的比较采用χ²检验或Fisher精确概率法。 结果所有调查者中≥50%的老年人其老年综合评估结果为异常,包括微营养状态、视力障碍、便秘及衰弱等。驻京某部队干休所老年人简易营养评价、简易智力状态测量、抑郁自评量表评分阳性患者比例,以及睡眠障碍、尿失禁、便秘、跌倒高风险、衰弱患者比例,均明显低于北京某高级养老机构,差异有统计学意义（χ²=29.463、4.226、5.591、9.899、-、5.000、11.168、5.333、0,P<0.05）。 结论养老机构引入专业医疗机构支持的医养结合养老模式更有利于健康、科学养老。