老年慢性病門診病患之潛在性不適當處方的相關危險因子探討

Risk Factors for Potentially Inappropriate Prescribing for Ambulatory Older Patients with Chronic Diseases

目的：探究門診老年慢性病患之潛在性不適當處方的相關危險因子。方法：本研究資料取自2009年7月到12月至中部某醫學中心家醫科門診開立慢性處方之65歲以上558位老年患者，根據病歷紀錄患者之年齡、性別、慢性病狀態以及處方藥物，使用2003年Beers criteria評估患者潛在性不適當處方。以Student's t檢定和卡方檢定各變項與潛在性不適當處方之相關性，進而以多變項邏輯式迴歸模式分析，探究潛在性不適當處方之危險因子。結果：研究對象平均年齡為74.9 ± 6.6歲；平均疾病診斷數目為5.2 ±2.6種；平均藥物數目為4.9 ± 2.6個；平均看診科別為1.3 ± 0.4科；平均處方籤數為1.4 ± 0.7張。其中107位(19.2%)有一項以上潛在性不適當處方。經多變項邏輯斯回歸分析顯示，潛在性不適當處方與藥物數目（勝算比= 1.35；95%信賴區間= 1.23-1.48；p < 0.001）、年齡（勝算比= 1.03；95%信賴區間= 1.01-1.07；p = 0.049）、以及精神疾病（勝算比= 1.85；95%信賴區間= 1.14-3.00；p = 0.010）有關。結論：本研究顯示潛在不適當處方在家醫科門診的慢性處方中並不少見，臨床醫師對於多種藥物處方、高齡以及精神疾病，應考慮其高風險性潛在不適當處方的可能性。

Objective: To identify the risk factors for potentially inappropriate prescribing for ambulatory older patients with chronic diseases. Methods: This study included 558 consecutive patients, aged ≥ 65 years with chronic diseases, who received long-term (3-month) prescriptions during their outpatient visits to family medicine clinics at a university hospital in central Taiwan between July 1 and December 31, 2009. Potentially inappropriate medication (PIM) was assessed according to the 2003 updated Beers criteria. Data regarding demographic characteristics, coexisting diseases, and ambulatory prescriptions were collected and analyzed. The clinical factors related to potentially inappropriate prescribing were determined using logistic regression. Results: The mean age of the 558 patients was 74.9 ± 6.6 years. The mean number of comorbid conditions was 5.2 ± 2.6; the mean number of drugs prescribed was 4.9 ± 2.6. PIM was identified in 107 patients (19.2%). Multivariate analysis revealed that PIM was significantly associated with the number of drugs prescribed (p＜ 0.001), advanced age (p= 0.049), and psychiatric illnesses (p= 0.010).Conclusions: Clinicians should be alert to the possibility of PIM in ambulatory older patients with chronic diseases, especially in those taking multiple medications and those who have advanced age or psychiatric illnesses.