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老年多重用药住院患者的用药现状评估及药师干预效果评价
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| 篇名： | 老年多重用药住院患者的用药现状评估及药师干预效果评价 |
| TITLE： | |
| 摘要： | 目的：评估老年多重用药住院患者的用药状况，评价临床药师开展药学服务的效果，为老年患者临床用药合理化提供参考。方法：选择2018年10月－2019年2月于首都医科大学附属北京友谊医院住院且存在多重用药的老年患者，通过老年综合评估团队构建并开展老年住院患者的药学服务流程；结合欧洲医药保健网分类系统对药物相关问题进行分析，采用Bayliff工具评价药物相关问题的危害程度以评价其用药现状；采用Morisky调查问卷分析患者用药依从性，并随访患者出院3个月后的用药情况以评价药师干预的效果。结果：共纳入71例存在多重用药现象的老年住院患者，其中52例患者（73.24％）存在54个药物相关问题，其中32个（59.26％）与治疗有效性相关，13个（24.07％）为发生药物不良事件（可能存在），9个（16.67％）为不必要的药物治疗问题。药物相关问题发生原因共有69个，其中医嘱原因有58个（84.06％），以药物选择（36.23％）、药物剂量（24.64％）和药物剂型（20.29％）为主。临床药师共进行了143次干预，干预成功102次，成功率为71.33％。干预接受程度最高的是药物不良事件上报（100％），其次涉及患者层面（97.56％）、医师层面（65.12％）和药物层面（52.83％）。54个药物相关问题中潜在危害程度以1级危害最多，有35个（64.81％）。经临床药师用药教育后，患者用药依从性评分为（6.19±0.58）分，显著高于其入院初期评分（4.13±1.62）分（P＜0.05）。随访结果显示，有6例患者自行停药，13例患者自行加服药物。结论：该院大部分老年多重用药住院患者普遍存在药物相关问题。临床药师可根据临床实际情况建立适合临床需求的可行的药学服务流程，同时可借助相关用药标准、药品说明书和用药软件等评估工具，根据患者的生理病理情况，与医师共同为老年患者选择适宜的治疗药物，减少多重用药和不合理用药，以提高老年患者用药的有效性和安全性。 |
| ABSTRACT： | OBJECTIVE： To evaluate the medication of elderly inpatients receiving multiple medication， to evaluate the effects of pharmaceutical care provided by clinical pharmacists， and to provide reference for clinical drug use of elderly patients. METHODS： The elderly inpatients receiving multiple medication were selected from Beijing Friendship Hospital Affiliated to Capital Medical University during Oct. 2018 to Feb. 2019. The process of pharmaceutical care for elderly inpatients was established and developed through the CGA team of the elderly. PCNE classification system was used to analyze drug-related problems； Bayliff tool was used to evaluate the harmfulness of drug-related problems； Morisky questionnaire was used to analyze medication compliance. Drug use was followed up 3 months after discharge to evaluate the effect of clinical pharmacist’s intervention. RESULTS： A total of 71 elderly inpatients with multiple medication were included， 73.24％ of them （52 patients） suffered from 54 drug-related problems， 32 of which were related to therapeutic effects （59.26％）， 13 （24.07％） drug adverse events （possible）， 9 unnecessary drug therapy problems （16.67％）. There were 69 causes of pharmaceutical related problems， of which 58 （84.06％） were doctor’s orders. The main causes were drug selection （36.23％）， drug dosage （24.64％） and drug dosage form （20.29％）. Totally 143 interventions were conducted by clinical pharmacists， including 102 successful interventions， with success rate of 71.33％. The highest acceptance of intervention was adverse drug events reporting（100％）， followed by patient level （97.56％）， doctor level （65.12％） and drug level （52.83％）. Among 54 pharmaceutical-related problems， the most potential hazards were grade 1 hazards， involving 35 problems （64.81％）. The score of medication compliance in patients who received medication education from clinical pharmacists was （6.19±0.58）， which was significantly higher than （4.13±1.62） at the initial stage of admission （P＜0.05）. Follow-up results showed that 6 patients discontinued drugs by themselves， and 13 patients took drugs additionally by themselves. CONCLUSIONS： Drug related problems were common in elderly inpatients receiving multiple medication. Clinical pharmacists can establish a feasible pharmaceutical care process suitable for clinical needs according to the actual clinical situation. With the help of relevant evaluation tools such as relevant drug criteria， drug instructions and drug software， and at the same time， according to the physiological and pathological conditions of patients， they can cooperate with clinicians to select suitable therapeutic drugs for elderly patients to reduce the phenomenon of unreasonable medication and multiple medication， so as to improve the effectiveness and safety of drug use in the elderly. |
| 期刊： | 2019年第30卷第22期 |
| 作者： | 吴汀溪，邢云利，黄凤，续畅，余俊先 |
| AUTHORS： | WU Tingxi，XING Yunli，HUANG Feng，XU Chang，YU Junxian |
| 关键字： | 老年患者；多重用药；老年综合评估；欧洲医药保健网分类系统；临床药师；药学服务 |
| KEYWORDS： | Elderly； Multiple medication； Comprehensive geriatric assessment； PCNE classification system； Clinical pharmacist； Pharmaceutical care |
| 阅读数： | 942 次 |
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