| 摘要: | 本研究為了解國內社區健保藥局接受處方調劑，老人用藥適當性評估問題及各相關易發生危險因素。目的為分析社區健保藥局接受調劑處方箋時，老年病人潛在性不適當用藥之型態、盛行率與容易發生不適當用藥之因素。研究方法為橫斷回溯性研究，以2012 AGS Beer’s Criteria準則為依據，進行老人潛在性不適當用藥評估，進行logistic多項式回歸分析相關危險因子。結果，2009?2012年共170,416人次。其中，65歲以上老年處方箋有63,610人次，以慢性病連續處方調劑佔84.8%為最多，近地域調劑病人佔97.6%。其中65歲以上潛在性不適當用藥共32,761人次，盛行率為51.5%。在不適當藥物使用型態中，和診斷疾病無關，但老人避免使用的藥物佔86.5%最多。潛在性不適當用藥單張處方平均用藥品項數4.18 ± 2.18，有使用5種以上用藥處方箋佔40.2%。常見不適當使用藥物前三名為antithrombotic agents , psycholeptics , cardiac therapy，其中男性用藥前五名：低劑量aspirin , doxazosin , isosorbide , alprazolam , dipyridamole。女性用藥前五名：低劑量aspirin , alprazolam , dipyridamole , clonazepam , lorazepam是否發生「潛在性不適當用藥」相關因素之logistic多項式回歸分析：看診疾病，醫院層級、年齡、性別、用藥品項數、處方箋類型皆具有顯著相關因素。藥費則無顯著關聯性。本研究發現65歲以上老人處方中，高危險用藥品項數（≧5）高達所有調劑處方數之25.4%。結果顯示，社區藥師接受老年人處方調劑時，必須更注意其相關危險因子以提高老人用藥安全。遇到老年可能之用藥問題時，應指導病人用藥方式與可能發生之副作用，以提升藥師專業知能。
In this article, the study assessed the potentially inappropriate medications (PIM) with different related risk factors on elderly patients in Taiwan. Retrospective cohort analysis was conducted using a NHI community pharmacy claims data of patients aged 65 years or older from 2009 to 2012.The relevant risk factors in eldly patients on PIM were analyzed by logistic multiple regression, and the presence of PIM’s was identified according to the 2012 AGS Beer’s Criteria. There were 63,610 over 65 year elder’s community pharmacy claim data , where 84.8% patients had chronic diseases with these prescriptions , and 97.6% patients were residence adjacent to community pharmacy. There were 32,761 people potentially inappropriate medication, the prevalence rate was 51.5%. The average number of PIM were 4.18±2.181 and 40.2% of them were over 5 items. The most frequent PIM were antithrombotic agents , psycholeptics , and cardiac agents. The top five PIM in male were low dose aspirin , doxazosin , isosorbide , alprazolam , dipyridamole and in female were low dose aspirin , alprazolam , dipyridamole , clonazepam , lorazepam. The results under logistic multiple regression revealed that diseases, age, gender, the number of medications taken and hospital type were significantly related to having inappropriate medications.This study found that inappropriateness of medication in elderly is fairly noteworthy , up to 25.4% of all dispensing medicines were high-risk drugs ( the number of medications taken more than 5). It also indicated that when community pharmacists dispense prescriptions for elderly patients, they should pay more attention regarding these risk factors in order to improve medication safety in elderly population. Therefore, it can be concluded that community pharmacies will be able to high quality pharmaceutical care services and reduce the relative medical costs while reducing the prevalence of inappropriateness of medication in elderly. |
