Page 53 - 中国全科医学2022-16期

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health service center in Beijing from January 1 to December 31，2019. The prescriptions were evaluated by two pharmacists
with intermediate titles based on 2019 American Geriatrics Society Beers Criteria（abbreviated as Beers criteria）and Criteria
of Potentially Inappropriate Medications for Older Adults in China（abbreviated as China criteria），respectively. At the same
time，the researchers collected the relevant data of the prescriber，elderly patients and the content of the prescription， and
compared the differences in the characteristics of the prescriber，the prescription object and the prescription content of the
prescriptions with different evaluation results. Binary Logistic regression method was used to analyze the factors affecting PIP
prescribing and to conduct sensitivity analysis（selected prescriptions for patients ≥ 65 years of age）. Descriptive analysis
was used to describe the distribution of inappropriate medicine in PIP. Results A total of 815 outpatient prescriptions for
elderly patients were included，including 266（32.6%） PIP under the Beers criteria or 182（22.3%） PIP under the Chinese
criteria，respectively. According to the Beers criteria，the differences were statistically significant when comparing the age of
prescribers，the age of elderly patients，the proportion of those with the diagnosis of hypertension and insomnia，the number of
drug varieties，and the proportion of those with the drug categories of cardiovascular system drugs，antithrombotic drugs，central
nervous system drugs，and gastrointestinal system drugs between PIP and non-PIP（P<0.05）. According to the China criteria，
the differences were statistically significant when comparing the age or title distribution of prescribers，the proportion of those
with the diagnosis of hypertension，coronary heart disease，diabetes，insomnia and osteoarthritis，and the proportion of those
with the drug categories of cardiovascular system drugs，antithrombotic drugs，non-insulin hypoglycemic drugs，central nervous
system drugs and non-steroidal anti-inflammatory drugs（NSAIDs） between PIP and non-PIP（P<0.05）. The binary Logistic
regression results showed that，no matter under the Beers criterion or the Chinese criterion：the prevalence of coronary heart
disease or insomnia in elderly patients had an impact on the prescription of PIP，and the inclusion of antithrombotic agents in the
prescription was an influencing factor affecting the formation of PIP（P<0.05）. The results of the sensitivity analysis showed that
hypertension，coronary heart disease and insomnia in elderly patients have an impact on the prescribing of PIP；the inclusion of
antithrombotic medication in the prescription was an influencing factor affecting the formation of PIP（P<0.05）. According to
the Beers' criterion，266 PIP involved a total of 302 cases of inappropriate drug use，of which antithrombotic drugs accounted for
46.4%（140/302），central nervous system drugs accounted for 16.2%（49/302），endocrine system diabetes（non-insulin）
drugs accounted for 13.9%（42/302）. According to the Chinese criterion，182 PIP involved inappropriate medications in a
total of 205 cases，of which antithrombotic drugs accounted for 44.9%（92/205），central nervous system drugs accounted for
25.9%（53/205），oral NSAIDs accounted for 14.1%（29/205）. Conclusion Among the community outpatient prescriptions
for elderly patients, PIP accounted for a relatively high proportion. In the future，emphasis should be placed on community
physicians' knowledge of safe and rational drug use，the use of antithrombotic drugs should be standardized，and the review of
drug prescriptions for patients with hypertension，coronary artery disease and insomnia should be strengthened.
【Key words】 Community health services；Elderly adults；Potentially inappropriate medication list；Drug
prescriptions；Root cause analysis

［2］
老年患者作为社区卫生服务机构门诊的重点服务对 开具的干预策略 。年资和接受培训情况不同的处方者，
象 ［1］ ，常罹患多种慢性病，多存在多重用药的问题， 其开具 PIP 的情况也可能不同。然而，目前国内外已公
易被开具潜在不适当处方（PIP） ［1-3］ 。PIP 的开具不 开发表的基于处方者、处方对象及处方内容 3 个层面来
仅增加了老年人发生药物不良反应及潜在不适当用药的 探讨 PIP 开具影响因素的研究中，纳入的与处方者相关
风险，还可能导致药物不良事件发生、医疗资源消耗程 的变量较少，变量的划分相对简单，且多采用美国老年
度增加，进而增加老年人和国家的医疗负担 ［4-6］ 。因此， 医学会 Beers 标准（简称 Beers 标准） ［12-13］ 作为 PIP 的
在基层医疗环境下，分析影响 PIP 开具的潜在因素已成 判断依据。2018 年 2 月，中国老年保健医学研究会合
为近年来的研究热点 ［4-11］ 。既往针对 PIP 开具的影响 理用药分会、中华医学会老年医学分会等 5 个学会组织
因素研究多聚焦处方对象和处方内容层面 ［4-11］ ，如探 相关领域专家联合发布了《中国老年人潜在不适当用药
讨处方对象的年龄、患病种数、处方中的药品种数等与 判断标准（2017 版）》（简称中国标准） ［14］ 。梁华玉
PIP 之间的关系。除了关注处方中药品种数与 PIP 之间 等 ［15］ 通过同时采用中国标准和 Beers 标准对 296 万张门、
的联系外，明确处方中何种药物是导致该处方成为 PIP 急诊患者处方进行评价，发现在中国标准下，潜在不适
的关键性药物，对于降低医务人员未来开具 PIP 的风险 当用药的检出率更高。考虑两标准并非完全重合，本研
至关重要 ［1-3］ 。同时，一项系统综述结果提示，应根据 究以社区门诊老年患者为研究对象，聚焦处方者、处方
不同类型医生的特点针对性地制定和实施旨在减少 PIP 对象和处方内容 3 个层面，分别以 Beers 标准及中国标