社区老年慢性病患者合理用药审查系统的构建与评价
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摘要
随着人口老龄化进程的不断加快，老年人健康及合理用药问题愈加重要。老年人生理功能减退和多种疾病共患，常常多科就诊，多药并用，药物治疗方案复杂，易发生药物不良反应等用药相关问题，严重影响了老年人的健康及生活质量。由药师主导的用药审查干预被国外广泛用于减少老年用药的负性事件、提高药物治疗收益。本研究通过系统分析、抽样调查及类实验研究等方法对用药审查在我国的应用的必要性和可行性进行了深入细致的研究，为我国药政部门及医药工作者开展社区药学服务提供了现实依据和政策参考，主要包括三个部分：
首先，对2000-2010年间国内外关于社区老年慢性病患者用药相关问题的干预调查的效果进行系统评价，结果表明药师主导的用药审查对提高患者生命质量、降低住院率和死亡率无显著性影响，对精简用药数量，确定药学服务主题，提高患者药物治疗收益有较好的效果。系统评价为中国社区老年患者合理用药问题干预从理论方法、干预手段、干预效果评价和干预研究设计等提供了新的视角。
其次，本研究以石家庄市416例社区老年慢性病患者为研究对象，对其用药相关问题的流行特征系统深入的调查，探讨了社区老年患者服用潜在性不适当药物对其药物不良反应发生率的影响。结果显示随着用药数量的增加，社区老年患者服用潜在性不适当药物的几率增加，药物间相互作用的发生率和药物不良反应发生率也随之增加，高龄老年人焦虑的心理负担加大，生命质量呈下降趋势。国外广泛用于评价老年潜在性不适当用药的工具之一Beers判断标准（2003版）对预测我国社区老年患者发生药物不良反应有重要的应用价值，值得我国医生借鉴。EQ-5D量表对社区老年慢性病患者生命质量评价具有较好的应用价值。
最后，根据系统评价结果并结合我国社区老年用药基线调查结果，将Beers判断标准应用在我国社区老年慢性病患者的用药问题评价，从药物使用的安全性、有效性、经济性、适用性四个方面构建了适合我国国情的社区老年用药审查工具TMRCE，并对当前我国建立社区药学服务的必要性和可行性进行了探讨。随机对照实验表明，基于社区老年用药审查辅助工具包的用药审查干预对减少社区用药潜在风险较高人均具有较好的有效性和可行性，值得推广使用，为我国开展旨在提高社区老年药物治疗收益的药学服务进行了有益的探索和可借鉴的模式。
With the population aging process continues to accelerate, the health of theelderly and the rational use of drugs are more important.Elderly physiologicaldysfunction and comorbid with a variety of diseases, often multipath department visits,multi-drug use and complex medication,which is prone to adverse drug reactions andother drug related problems (DRPs), a serious impact on the health and quality of lifeof older persons.However, effective intervention strategies are uncommon. Thepharmacist-led medication review interventions abroad are widely used to reduce thenegative events of the older medication, to improve medication income.In this study,use the method of systematic review, sample survey, quasi-experimental research onthe necessity and feasibility of medication review in China conducted a thorough andmeticulous research, mainly consists of three parts:
Firstly, Systematic review the effect of domestic and foreign intervention trial onthe related issues of community elderly patients with chronic medication from2001-2010. The results show that pharmacist-led medication review(MR) can play animportant role in the identification, assessment and prevention of potential DRPs inthe elderly. No significant impact on the MR to improve the quality of life, reducinghospitalization and mortality.
Secondly, the study took416case of community elderly polypharmacyout-patients in Shijiazhuang city for example, in-depth investigated the popularfeatures of their medications, explored the impact of taking potentially inappropriatemedications to adverse drug reaction(ADR). The results showed that with the numberof medication increased the prevalence of potentially inappropriate drugs increasedtoo,meanwhile the incidence of drug interactions and ADR also increases.Thepolypharmacy elderly feel more anxiety which make the drop of quality of life.
Finally, according to the results of SR and baseline survey, build a medicationreview tools-TMRCE.Randomized controlled trials showed that TMRCE have abetter effectiveness and feasibility to reduce the potential risk of eldly medication.Itis worth to promote the use of medication review tools TMRCE.
首先，对2000-2010年间国内外关于社区老年慢性病患者用药相关问题的干预调查的效果进行系统评价，结果表明药师主导的用药审查对提高患者生命质量、降低住院率和死亡率无显著性影响，对精简用药数量，确定药学服务主题，提高患者药物治疗收益有较好的效果。系统评价为中国社区老年患者合理用药问题干预从理论方法、干预手段、干预效果评价和干预研究设计等提供了新的视角。
其次，本研究以石家庄市416例社区老年慢性病患者为研究对象，对其用药相关问题的流行特征系统深入的调查，探讨了社区老年患者服用潜在性不适当药物对其药物不良反应发生率的影响。结果显示随着用药数量的增加，社区老年患者服用潜在性不适当药物的几率增加，药物间相互作用的发生率和药物不良反应发生率也随之增加，高龄老年人焦虑的心理负担加大，生命质量呈下降趋势。国外广泛用于评价老年潜在性不适当用药的工具之一Beers判断标准（2003版）对预测我国社区老年患者发生药物不良反应有重要的应用价值，值得我国医生借鉴。EQ-5D量表对社区老年慢性病患者生命质量评价具有较好的应用价值。
最后，根据系统评价结果并结合我国社区老年用药基线调查结果，将Beers判断标准应用在我国社区老年慢性病患者的用药问题评价，从药物使用的安全性、有效性、经济性、适用性四个方面构建了适合我国国情的社区老年用药审查工具TMRCE，并对当前我国建立社区药学服务的必要性和可行性进行了探讨。随机对照实验表明，基于社区老年用药审查辅助工具包的用药审查干预对减少社区用药潜在风险较高人均具有较好的有效性和可行性，值得推广使用，为我国开展旨在提高社区老年药物治疗收益的药学服务进行了有益的探索和可借鉴的模式。
With the population aging process continues to accelerate, the health of theelderly and the rational use of drugs are more important.Elderly physiologicaldysfunction and comorbid with a variety of diseases, often multipath department visits,multi-drug use and complex medication,which is prone to adverse drug reactions andother drug related problems (DRPs), a serious impact on the health and quality of lifeof older persons.However, effective intervention strategies are uncommon. Thepharmacist-led medication review interventions abroad are widely used to reduce thenegative events of the older medication, to improve medication income.In this study,use the method of systematic review, sample survey, quasi-experimental research onthe necessity and feasibility of medication review in China conducted a thorough andmeticulous research, mainly consists of three parts:
Firstly, Systematic review the effect of domestic and foreign intervention trial onthe related issues of community elderly patients with chronic medication from2001-2010. The results show that pharmacist-led medication review(MR) can play animportant role in the identification, assessment and prevention of potential DRPs inthe elderly. No significant impact on the MR to improve the quality of life, reducinghospitalization and mortality.
Secondly, the study took416case of community elderly polypharmacyout-patients in Shijiazhuang city for example, in-depth investigated the popularfeatures of their medications, explored the impact of taking potentially inappropriatemedications to adverse drug reaction(ADR). The results showed that with the numberof medication increased the prevalence of potentially inappropriate drugs increasedtoo,meanwhile the incidence of drug interactions and ADR also increases.Thepolypharmacy elderly feel more anxiety which make the drop of quality of life.
Finally, according to the results of SR and baseline survey, build a medicationreview tools-TMRCE.Randomized controlled trials showed that TMRCE have abetter effectiveness and feasibility to reduce the potential risk of eldly medication.Itis worth to promote the use of medication review tools TMRCE.
引文
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