老年住院病人潜在不恰当用药发生率、药物分布及影响因素

发布时间：2018-01-20 01:52

本文关键词： Beers标准老年住院病人不恰当用药联合用药　出处：《西安医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的和意义:研究老年住院病人潜在不恰当用药发生率、药物分布及影响因素。老年人因其自身特点存在多病共存与多重用药,加上老年人器官功能减退,药物代谢、排泄速率降低,药物不良反应事件发生率高。药物不良反应事件增加了老年人的住院花费及死亡率,增加了国家医疗保险开销。本研究分析老年住院病人潜在不恰当用药发生率、药物分布及影响因素的现况,从而为采取针对性措施降低老年住院病人潜在不恰当用药的发生率提供理论依据。研究方法:随机抽取符合纳入标准的陕西省人民医院住院病人699例,使用Beers标准(2015版)评价病例,采用频率统计方法、Kruskal-Wallis H检验、单因素logistic回归分析及多因素logistic回归分析进行统计描述及推断。结果:1.老年住院病人潜在不恰当用药发生率为79.5%,其中血管扩张剂(45.9%)、利尿剂(34.8%)、NSAIDs(26.3%)位居前三;2.根据多个独立样本的秩和检验,四类不同年资开嘱医师的老年住院病人潜在不恰当用药发生数量比较结果,Χ2=6.115,P=0.106;3.根据逐步法Logistic回归分析进入模型的自变量为联合用药数量(OR=2.779,P=0.000)、住院科室(OR=0.489,P=0.001)、医保类型(OR=1.219,P=0.048),未进入模型的自变量包括:年龄(P=0.729)、性别(P=0.376)、罹患疾病数量(P=0.663)、住院天数(P=0.213)。结论:(1)老年住院病人潜在不恰当用药发生率高,主要集中在血管扩张剂、利尿剂、NSAIDs;(2)不同开嘱医师年资与老年住院病人潜在不恰当用药数量之间无统计学差异;(3)医保类型、联合用药数量、住院科室是发生老年住院病人潜在不恰当用药的影响因素且联合用药数量多、医保报销比例高的老年住院病人更容易发生潜在不恰当用药,内科病房相对外科病房的老年住院病人更容易发生潜在不恰当用药;(4)年龄、性别、罹患疾病数量、住院天数与是否发生老年住院病人潜在不恰当用药无关。
[Abstract]:Objective and significance: to study the incidence of potential inappropriate drug use, drug distribution and influencing factors in elderly inpatients. Drug metabolism, low excretion rate, high incidence of adverse drug events. Adverse drug events increased the cost of hospitalization and mortality of the elderly. This study analyzed the incidence of potential inappropriate drug use, drug distribution and influencing factors in elderly inpatients. So as to take targeted measures to reduce the incidence of potential inappropriate use of drugs for elderly inpatients to provide theoretical basis. Methods: random sampling of 699 inpatients in Shaanxi Provincial people's Hospital who meet the inclusion criteria. Cases were evaluated using Beers standard (2015) and Kruskal-Wallis H test was used for frequency statistics. Univariate logistic regression analysis and multivariate logistic regression analysis were used to describe and infer the statistical results. Results: 1. The incidence of potential inappropriate drug use in elderly inpatients was 79.5%. The vasodilators were 45.9 and the diuretics 34.8and NSAIDs26.3respectively. 2.According to the rank sum test of several independent samples, the results of comparison of the number of potential inappropriate drug use among the four categories of inpatients with different years of service were as follows: (2) 6.115 / 0.106; 3.According to the stepwise Logistic regression analysis, the independent variables entered into the model were: the number of combined drugs was 0.0000.000, and the number of inpatients was 0.489. The independent variables not included in the model include: age: P0. 729, gender: P0. 376). (P < 0. 001, P = 0. 001, P = 1. 219, P = 0. 048, P = 0. 729, P = 0. 376). The number of diseases was 0.663g, and the length of hospitalization was 0.2130.Conclusion the incidence of potential inappropriate use of drugs in elderly inpatients is high, mainly in vasodilators and diuretics. NSAIDs; (2) there was no statistical difference between the years of different prescribing physicians and the number of potentially inappropriate drugs used by elderly inpatients; 3) the type of medical insurance, the number of combined drugs, and the inpatient department are the influence factors of the potential inappropriate use of drugs in the elderly inpatients and the number of combined drugs is more. The inpatients with high proportion of medical insurance reimbursement are more likely to have potentially inappropriate medication, and the medical ward is more likely to develop potentially inappropriate medication than the elderly inpatients in the surgical ward. Age, sex, number of diseases, length of stay were not associated with potential inappropriate use of drugs for elderly inpatients.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R95

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