本文關鍵詞： Beers標準 老年住院病人 不恰當用藥 聯(lián)合用藥　出處：《西安醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的和意義:研究老年住院病人潛在不恰當用藥發(fā)生率、藥物分布及影響因素。老年人因其自身特點存在多病共存與多重用藥,加上老年人器官功能減退,藥物代謝、排泄速率降低,藥物不良反應事件發(fā)生率高。藥物不良反應事件增加了老年人的住院花費及死亡率,增加了國家醫(yī)療保險開銷。本研究分析老年住院病人潛在不恰當用藥發(fā)生率、藥物分布及影響因素的現(xiàn)況,從而為采取針對性措施降低老年住院病人潛在不恰當用藥的發(fā)生率提供理論依據(jù)。研究方法:隨機抽取符合納入標準的陜西省人民醫(yī)院住院病人699例,使用Beers標準(2015版)評價病例,采用頻率統(tǒng)計方法、Kruskal-Wallis H檢驗、單因素logistic回歸分析及多因素logistic回歸分析進行統(tǒng)計描述及推斷。結果:1.老年住院病人潛在不恰當用藥發(fā)生率為79.5%,其中血管擴張劑(45.9%)、利尿劑(34.8%)、NSAIDs(26.3%)位居前三;2.根據(jù)多個獨立樣本的秩和檢驗,四類不同年資開囑醫(yī)師的老年住院病人潛在不恰當用藥發(fā)生數(shù)量比較結果,Χ2=6.115,P=0.106;3.根據(jù)逐步法Logistic回歸分析進入模型的自變量為聯(lián)合用藥數(shù)量(OR=2.779,P=0.000)、住院科室(OR=0.489,P=0.001)、醫(yī)保類型(OR=1.219,P=0.048),未進入模型的自變量包括:年齡(P=0.729)、性別(P=0.376)、罹患疾病數(shù)量(P=0.663)、住院天數(shù)(P=0.213)。結論:(1)老年住院病人潛在不恰當用藥發(fā)生率高,主要集中在血管擴張劑、利尿劑、NSAIDs;(2)不同開囑醫(yī)師年資與老年住院病人潛在不恰當用藥數(shù)量之間無統(tǒng)計學差異;(3)醫(yī)保類型、聯(lián)合用藥數(shù)量、住院科室是發(fā)生老年住院病人潛在不恰當用藥的影響因素且聯(lián)合用藥數(shù)量多、醫(yī)保報銷比例高的老年住院病人更容易發(fā)生潛在不恰當用藥,內科病房相對外科病房的老年住院病人更容易發(fā)生潛在不恰當用藥;(4)年齡、性別、罹患疾病數(shù)量、住院天數(shù)與是否發(fā)生老年住院病人潛在不恰當用藥無關。
[Abstract]:Objective and significance: to study the incidence of potential inappropriate drug use, drug distribution and influencing factors in elderly inpatients. Drug metabolism, low excretion rate, high incidence of adverse drug events. Adverse drug events increased the cost of hospitalization and mortality of the elderly. This study analyzed the incidence of potential inappropriate drug use, drug distribution and influencing factors in elderly inpatients. So as to take targeted measures to reduce the incidence of potential inappropriate use of drugs for elderly inpatients to provide theoretical basis. Methods: random sampling of 699 inpatients in Shaanxi Provincial people's Hospital who meet the inclusion criteria. Cases were evaluated using Beers standard (2015) and Kruskal-Wallis H test was used for frequency statistics. Univariate logistic regression analysis and multivariate logistic regression analysis were used to describe and infer the statistical results. Results: 1. The incidence of potential inappropriate drug use in elderly inpatients was 79.5%. The vasodilators were 45.9 and the diuretics 34.8and NSAIDs26.3respectively. 2.According to the rank sum test of several independent samples, the results of comparison of the number of potential inappropriate drug use among the four categories of inpatients with different years of service were as follows: (2) 6.115 / 0.106; 3.According to the stepwise Logistic regression analysis, the independent variables entered into the model were: the number of combined drugs was 0.0000.000, and the number of inpatients was 0.489. The independent variables not included in the model include: age: P0. 729, gender: P0. 376). (P < 0. 001, P = 0. 001, P = 1. 219, P = 0. 048, P = 0. 729, P = 0. 376). The number of diseases was 0.663g, and the length of hospitalization was 0.2130.Conclusion the incidence of potential inappropriate use of drugs in elderly inpatients is high, mainly in vasodilators and diuretics. NSAIDs; (2) there was no statistical difference between the years of different prescribing physicians and the number of potentially inappropriate drugs used by elderly inpatients; 3) the type of medical insurance, the number of combined drugs, and the inpatient department are the influence factors of the potential inappropriate use of drugs in the elderly inpatients and the number of combined drugs is more. The inpatients with high proportion of medical insurance reimbursement are more likely to have potentially inappropriate medication, and the medical ward is more likely to develop potentially inappropriate medication than the elderly inpatients in the surgical ward. Age, sex, number of diseases, length of stay were not associated with potential inappropriate use of drugs for elderly inpatients.
【學位授予單位】：西安醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R95

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本文編號：1446366