長期照顧機構中中風住民潛在不適當的藥物使用：使用Beers標準觀察的個案

Potentially inappropriate medication use among stroke residents of a long-term care facility: an observational case study using the Beers Criteria

目標：研究欲探索長期照顧機構罹患中風住民（≥65歲）在潛在不適當用藥之人口變項情形、藥品類項，以及處方優化的合作經驗。方法：本研究是個案研究法，對象為台北市某區域醫院附設長期照顧機構22位住民，使用前瞻性的橫斷式研究蒐集資料，包含有（一）長期照顧機構住民基本資料（性別、年齡、用藥種類）和（二）不適當用藥盛行率、介入用藥結果。結果：本研究參與對象的慢性疾病數以4種最多，處方用藥數則以6-10種居多，在潛在不適當用藥方面，以Quetiapine居多。在處方優化有15位住民用藥需與醫師討論處方優化事宜，所佔比例為68.2％。結論：本研究透過2019年的Beers標準，發現長期照顧機構罹患中風住民用藥狀況有其特殊性，醫師依據個別住民的特定情況，考量藥物使用之目的性、有效性、迫切性、劑量合理性等，建議採用醫師與藥師的合作模式，並搭配Beers標準為參考，以降低潛在不適當用藥與處方優化。

Objectives: The demographic variables and drug use of stroke residents (aged ≥ 65 years) in long-term care facilities were explored for potentially inappropriate medication use, and a cooperation model for prescription optimization was examined. Methods: A total of 22 residents of a regional hospital in Taipei City were included. Data on the following were collected through a prospective cross-sectional method: (1) basic information (sex, age, types of medication), (2) prevalence of potentially inappropriate medication use, and (3) results of the medication intervention. Results: The maximum number of chronic diseases of any participant was four. The participants used 6 to 10 prescribed medications. Quetiapine was the foremost potentially inappropriate medication. The medications of 15 residents (68.2% of the participants) required discussion with attending physicians for deprescribing. Conclusions: Using the Beers criteria, the study determined that the prescriptions and medications of stroke residents in a long-term care facility exhibited unique characteristics. Attending physicians consider factors including the purpose, effectiveness, urgency, and rationality of dosage according to the specific conditions of individual residents when making prescriptions. The adoption of a cooperation model between physicians and pharmacists is recommended, as is the use of the Beers criteria as a reference to reduce potentially inappropriate medications and to promote prescription optimization.