老化影響藥物動力學的變化，導致藥效的改變，因而易於對藥品產生不良反應，同時也存在著潛在性不適當藥品的問題。老年人往往容易罹患多重疾病，並常跨院所就診，取得多種處方藥品與用藥的複雜，導致藥品交互作用的增加。因以上特異性可能導致不合適的健康照護，本著參與多年居家藥事照護藥師職責，希望能了解機構住民與高診次病人年長者的潛在性不適當藥品的盛行率。
本研究分析2013年至2017年期間機構與高診次之兩來源個案，機構有兩家。高診次收案對象依照健保署定義為前1年申報門診就醫次數大於90次，且符合以下條件其中之一者：具有2種以上慢性疾病者，其在大於2家院所領取大於13張慢性病連續處方箋者；或藥費在前50%且就醫院所家數大於8家者；或半數以上處方箋之藥品品項大於7種者；或西醫基層醫師認為需要藥師專業輔導轉介之個案。
本研究依據美國老人醫學會2015年所制定的Beers Criteria來分析老年人不適當用藥的盛行率，不適當用藥依器官系統、治療類別進行分類。個案基本資料描述統計，分析平均年齡、性別組成；用藥資料以次數分配指出其用藥品項傾向，不適當用藥以處方數量，並以卡方檢定兩收案來源差異。
收案對象中機構170名，男性68人、女性102人，高診次158名，男性89人、女性69人，兩收案對象性別比率不同(p=0.0030)。機構平均年齡平均81±6.1歲；高診次77±5.7歲，兩族群均年齡相似(p=0.1234)。平均每人用藥：機構住民6±1.02種、高診次8±1.78種，高診次個案用藥較多(p<0.0001)，潛在不適當用藥盛行率分別為78%與74%，其中用藥類別中樞神經類用藥43%與42%、心血管類用藥27%與39%、胃腸科用藥23%與8.1%、止痛藥5%與5.5%
機構及高診次的高齡年長者，皆有7成以上的潛在性不適當藥品盛行率，將使得年長者的健康有潛在的風險。在進行照護時藥師可密切注意是否有相關的藥品相關問題如易於跌倒或有口乾及胃腸蠕動過慢的副作用發生，以避免不適宜的健康照護結果而濫用緊急醫療。因此，為維護年長者的健康與較好的生活品質，藥師的介入居家藥事照護是非常有意義且刻不容緩的事情。 Elderly are prone to potentially inappropriate medication (PIM) due to multiple drug from multiple treatments. Multiple medication makes elderly more likely to experience drug interactions. This research used Beers criteria 2015 version to judge the prevalence of PIM within the sample population from the in residential care homes and the frequent users of outpatient services. During the period of intervention, it analyzes the average age and gender composition from the two sources, and identifies the prevalence of potentially inappropriate medication among these cases. It then analyzes the prevalence of PIMs by dividing the total amount of PIMs by the number of prescriptions.
The results show that residential care homes of male and female was 69 and 89 individuals, with the average of 6 types of drug, prevalence rate is 78%, and the PIM was classified as 43% of central nervous system acting drugs, 27% of cardiovascular drugs, 23% of gastrointestinal drugs, and 5% analgesics are PIM.
The frequent users of outpatient services of male and female was 102 and 89 individuals, the average medication was 8 types, prevalence rate is 74%, and 42% of CNS acting drugs, 39% of cardiovascular drugs, 8.1% of gastrointestinal drugs and the 5.5% of analgesics are classify as PIM.
Therefore, elderly in residential care homes and the frequent users of outpatient services have similar problems with the use of potentially inappropriate drugs. Therefore, it is very meaningful and urgent for pharmacists to intervene elderly’s medication to prevent PIM. In order to maintain the health and good quality of life of the elderly, it is very meaningful and urgent for pharmacists to intervene in home pharmacy care.
