頁籤選單縮合
題 名 | 降低老年患者之潛在不當用藥=Decreasing the Use of Potentially Inappropriate Medications among Elderly Patients |
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作 者 | 李惠超; 紀柏羽; 曾淑玲; 蔡敏鈴; 陳宣志; | 書刊名 | 藥學雜誌 |
卷 期 | 30:3=120 2014.09[民103.09] |
頁 次 | 頁146-150 |
分類號 | 418.82 |
關鍵詞 | 潛在性不適當用藥; 醫療資訊系統; 老年患者; Potentially inappropriate medications; Hospital information system; Elderly patient; |
語 文 | 中文(Chinese) |
中文摘要 | 目標:研究透過醫院資訊系統 (hospital information system, HIS) 降低老年患者使 用潛在不適當用藥 (potentially inappropriate medications, PIMs) 之成效。 方法:本研究共分為兩階段,第一階段評估2011年10月至12月間年齡大於或等 於65歲且長期使用藥物 (處方天數 ≧ 28天) 的患者所使用的藥品,以2012 AGS Beers Criteria 列舉「須避免使用的藥物」為依據,找出研究對象最常使用的 PIMs。CSPIMs (Chung Shan PIMs) 為本院醫師、藥師組成之專家團隊所定義本院不建議老年患者使 用之 PIMs,並於2013年1月1日起開始透過 HIS 警示;第二階段評估2013年1月至3月 間 HIS 介入後研究對象 CSPIMs 的使用情況。 結果:在第一階段12,237名研究對象中,有4,437名患者 (36.2%) 所服用的藥 品至少有一種或一種以上是 PIM,包含 zolpidem (23.7%)、dipyridamole (20.5%) 與 glyburide (15.7%) 等共計49項藥品,經專家團隊定義12項藥品為 CSPIMs 並於 HIS 系 統設定警示。排除第二階段未繼續領藥之病人,本研究共追蹤9,062老年患者,平均 年齡75.5 ± 6.5歲,其中男性佔44.6%。HIS 警示介入前,有2,660名 (29.4%) 老年患 者使用了3,288個 CSPIMs;HIS 警示介入後,服用藥品中有 CSPIMs 的患者減少為 1,645名 (18.2%, p < 0.001),平均每位患者減少使用0.12個 CSPIMs (p < 0.001),其中 以 estazolam、lorazepam 和 clonazepam 三種藥品使用病人數減少最多。 結論:透過 HIS 之 CSPIMs 警示,可明顯減少長期服用藥品的老年患者使用 CSPIMs。 |
英文摘要 | Objective: To determine the effectiveness of interventions by hospital information system (HIS) to decrease the use of potentially inappropriate medications (PIMs) among elderly patients. Methods: The study is divided into two stages; the first stage of the study is to detect which PIMs have always been prescribed in elderly patients (≧ 65 years) with long-term prescription (≧ 28 days) during October to December 2011. PIMs were assessed according to "medications to avoid in older adults" listing in 2012 Beers criteria. CSPIMs were PIMs defined by the expert panel members (e.g., geriatric medicine and pharmacy practice) which medications are suggested not to be prescribed among elderly patients in our hospital. Second stage of the study is to find out the change in usage of CSPIMs of cohort during January to March 2013 after intervention by HIS. Results: Among 12,237 patients in first stage of study, 4,437 (36.2%) patients were prescribed with at least ≧ 1 PIMs. There are 49 kinds of PIMs including zolpidem (23.7%), dipyridamole (20.5%), glyburide (15.7%), etc. There are 12 kinds of CSPIMs selected by expert panel members and were set interventions in HIS. Excluded patients who did not refill their prescriptions, there are 9,062 elderly patients included in the cohort; the mean age of the patients was 75.5±6.5 years and 44.6% were males. Before interventions of HIS, 2,660 elderly patients (29.4%) received 3,288 CSPIMs. After interventions of HIS, the number of elderly patients who take CSPIMs was declined to 1,645 (18.2%, p < 0.001), the average of received CSPIMs by each patient decreased to 0.12 (p < 0.001). The top three CSPIMs reduced in the number of patients are estazolam, lorazepam and clonazepam. Conclusions: Interventions by HIS do reduce prescribing CSPIMs among elderly patients who taking medicines for a long time. |
本系統中英文摘要資訊取自各篇刊載內容。