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德美日FORTA系统用于老年患者多重用药分级管理的比较
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| 篇名： | 德美日FORTA系统用于老年患者多重用药分级管理的比较 |
| TITLE： | Comparison of German，American and Japanese FORTA systems for hierarchical management of polypharmacy in elderly patients |
| 摘要： | 目的 为我国老年患者多重用药的分级管理提供借鉴与参考。方法介绍老年患者用药分级系统FORTA（fitfortheaged）的制定与发展过程，以老年患者常见的心脑血管系统疾病、神经精神类疾病治疗药物为例，比较德美日3版FORTA清单中疾病类型、药物种类及药物分级情况。结果与结论FORTA系统是首个将正面和负面标签相结合的分类系统，通过两轮德尔菲法形成，涵盖多种疾病和药物条目。FORTA清单涉及的心脑血管系统疾病主要包括急性冠脉综合征、心肌梗死后的长期治疗、心力衰竭、房颤、高血压、中风等。对于急性冠脉综合征、心肌梗死后的长期治疗和中风，相关药物的分级多为A级，3版清单的差异较小；其他疾病治疗药物分级有所差异。FORTA清单涉及的神经精神类疾病包括痴呆、癫痫、帕金森病、失眠/睡眠障碍、抑郁和双相情感障碍等，相关药物的分级多为负面标签，以C级和D级居多，仅有治疗帕金森病的左旋多巴为A级；3版清单中抗癫痫药物和治疗双相情感障碍的药物（除锂剂）分级较为统一，其余药物分级有所差异。相较于美国和日本的FORTA系统，德国FORTA系统更新了药物种类和临床证据，优化了疾病和药物分类，在一些药物分级上可能更为严格。3版FORTA清单中分级统一的药物可能具有较广的应用范围，我国可结合以上内容与临床实际，制定老年患者用药分级管理系统，以优化老年患者的用药选择，改善其临床治疗结局。 |
| ABSTRACT： | OBJECTIVE To provide reference for the hierarchical management of polypharmacy in elderly patients in China. METHODS The formulation and development process of drug hierarchical management system FORTA （fit for the aged） for elderly patients was introduced. The treatment drugs for common cardiovascular system diseases and neuropsychiatric diseases in elderly patients were taken as examples， the disease types， drug types and drug hierarchy in Germany-FORTA， the U.S.-FORTA and Japan-FORTA were compared. RESULTS & CONCLUSIONS FORTA system was the first drug hierarchical system that combined positive and negative labels， formed through two rounds of Delphi method and covered a variety of diseases and drug items. The cardiovascular system diseases covered by the FORTA list mainly included acute coronary syndrome， chronic therapy following myocardial infarction， heart failure， atrial fibrillation， hypertension， stroke， etc. For acute coronary syndrome， chronic therapy following myocardial infarction and stroke， the related drugs were mostly class A， and the differences between those FORTA lists were minimal. The hierarchy of drugs used to treat other diseases was various. The neuropsychiatric diseases covered by the FORTA list included dementia， epilepsy， Parkinson’s disease， insomnia/sleep disorder， depression and bipolar disorder， etc.， and the drug’s hierarchy was mostly labelled with negative， mostly class C and class D， and only levodopa to treat Parkinson’s disease was class A. The hierarchy of antiepileptic drugs and drugs for the treatment of bipolar disorder （except lithium） was relatively uniform in three FORTA lists， while the hierarchy of other drugs was different. Compared with the FORTA system in the U.S. and Japan， the Germany-FORTA system updated the drug types and clinical evidence， optimized the hierarchy of diseases and drugs， and may be stricter in some drug hierarchies. The drugs with uniform hierarchy in those FORTA lists may have a wide application range，and our country can combine the above content with clinical practice to formulate a drug hierarchical management system for elderly patients to optimize the drug selection of elderly patients and improve their clinical outcomes. |
| 期刊： | 2023年第34卷第06期 |
| 作者： | 张倩；李少强；张镭；李朋梅 |
| AUTHORS： | ZHANG Qian，LI Shaoqiang，ZHANG Lei，LI Pengmei |
| 关键字： | FORTA系统；老年患者；多重用药；分级管理；德国；美国；日本 |
| KEYWORDS： | FORTA system； elderly patients； polyphar- |
| 阅读数： | 668 次 |
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