頁籤選單縮合
題 名 | 臺灣老年門診病患多重用藥的整合性及持續性照護=Continuous and Integrated Care of Elderly Outpatients with Polypharmacy in Taiwan |
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作 者 | 陳明正; 余文瑞; 翁林仲; 何清幼; | 書刊名 | 北市醫學雜誌 |
卷 期 | 9:1 2012.03[民101.03] |
頁 次 | 頁21-29 |
分類號 | 418.1 |
關鍵詞 | 多重用藥; 藥物不良反應; 老年整合性門診; Polypharmacy; Adverse drug reaction; Integrated geriatric clinic; |
語 文 | 中文(Chinese) |
中文摘要 | 由於老年病患經常有多重慢性疾病,因此多重用藥的問題在老年病患身上相當常見。多重用藥不僅會增加藥物不良反應的風險也會降低病患對服藥的順從性,甚至增加住院率及死亡率。本研究的目的在探討老年多重用藥的盛行率及實施「老年整合門診」對減少不當用藥的實際成效。方法:臺北市立聯合醫院陽明院區設立老年整合性門診,自2009年5月11日至2011年1月底止,針對多重用藥、多科就診或出現急性日常生活功能下降併有老年症候群的老年患者,施行周全性評估及整合性的醫療照顧。結果:本研究總共99位老年病患(男性:47,女性:52),平均年齡77.6±9.9歲。39(40%)位體重過重,超過半數有腎功能缺損的問題[平均CLcr(creatinine clearance):48.3±21.4ml/min]。73位(73.7%)有使用另類治療,其中18%使用中草藥。多重用藥在第一次門診評估之盛行率高達72.7%,透過整合性門診的介入後,明顯降為58.6%。每天平均用藥品項在第一次門診時為7.3±4.1種,透過整合性門診的介入後,明顯降為6.3±3.0種(P<0.01)。多重用藥的問題明顯改善。結論:多重用藥的盛行率在臺灣老年病患相當高。我們發現透過整合性門診的介入,多重用藥的問題明顯獲得改善。透過整合性門診的照護模式,可持續減少不必要或過多的用藥,以維護老年病患的用藥安全。 |
英文摘要 | Polypharmacy (concurrent use of more than five different medications or unnecessary drugs) is highly prevalent in the elderly due to their increased number of co-morbid diseases. Polypharmacy not only increases the risk of ADRs (adverse drug reactions) but also lowers adherence to drug regimens. Both ADRs and low adherence to drug regimens are related to morbidity and mortality. The aim of this study was to identify the prevalence of polypharmacy and to assess the effectiveness of reducing inappropriate medication via attendance at an Integrated Geriatric Clinic (IGC). Methods: IGCs are an emerging new approach when treating patients with multiple medical needs. The clinic started in May 2009 in Taipei City Hospital, Yangming Branch. Elderly outpatients with polypharmacy consulted with an interdisciplinary team of professionals that included a geriatric specialist, a neurologist, physiatrist and pharmacist over 20 months. Results: A total of 99 patients (males: 47, females: 52) were enrolled at the IGC. The average age was 77.6±9.9 years. About half of the elderly had a normal BMI (Body Mass Index, normal range 18.5~23.9 Kg/m2) and 39 (40%) were overweight. More than half had renal function impairment [average CLcr (creatinine clearance): 48.3±21.4 ml/min]. Seventy-three patients (73.7%) took complementary medications, and 14.1% of them took Chinese herbal products. The prevalence of polypharmacy was 72.7% at the first clinic survey and this had significantly dropped to 58.6% at the final survey. The mean number of medications was 7.3±4.1 at initial visit compared with 6.3±3.0 at final visit. A statistically significant reduction in the total number of medications taken was observed. Conclusions: The prevalence of polypharmacy is extremely high among the Taiwanese elderly. We found a significant reduction in the number of medications being taken by the elderly could be brought about through continuous IGC intervention. To improve drug safety among this high-risk population, the goal of the IGC is to promote appropriate medication usage, and to reduce the incidence of polypharmacy. Comments: Health care professionals should be aware of ADR among the elderly. A reduction in the number of medications taken and in unnecessary drug use at each patient visit is an important issue that is closely related to drug safety. |
本系統中英文摘要資訊取自各篇刊載內容。