Occurrence investigation and influencing factor analysis on potentially inappropriate medication in discharge prescriptions in elderly patients with stroke
10.3760/cma.j.cn114015-20200114-00044
- VernacularTitle:脑卒中老年患者出院带药处方中潜在不适当用药情况调查及影响因素分析
- Author:
Yali WANG
1
;
Xiaojia FANG
1
;
Qian ZHANG
1
;
De CAI
1
Author Information
1. 汕头大学医学院第一附属医院药剂科，汕头 515041
- Publication Type:Journal Article
- Keywords:
Potentially inappropriate medication list;
Aged;
Stroke;
Aftercare
- From:
Adverse Drug Reactions Journal
2020;22(11):619-624
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the occurrence of potentially inappropriate medication (PIM) and its influencing factors in discharge prescriptions in elderly patients with stroke.Methods:The medical record data of elderly patients (≥65 years) with stroke, who were discharged from the Department of Neurology in the First Affiliated Hospital of Shantou University Medical College between July 2016 and December 2017, were collected and retrospectively analyzed. There were 2 wards in the Department of Neurology in total, 1 of which had clinical pharmacists to participate in medication management of the discharged patients. The patients′ basic information (gender, age, length of hospital stay, ward, and etc.), discharge diagnosis, and discharge prescriptions were collected. PIM in discharge prescriptions in the patients was evaluated according to the 2019 American Geriatrics Society Beers criteria. The patients were grouped according to their gender, age (65-74, 75-84, ≥85 years), number of diseases (1-5, 6-10, ≥11), Charlson comorbidity index (1, 2, ≥3), length of hospital stay (<15, 16-20, ≥21 d), number of prescribed drugs (1-4, 5-9, ≥10), and with or without clinical pharmacists involving in medication management in the ward, and the occurrence of PIM was compared. The influencing factors of PIM were analyzed using multivariate logistic regression method.Results:A total of 435 patients were included in the analysis. Of them, 230 were males and 205 were females, with ages from 65 to 92 years; the number of drugs in discharge prescriptions ranged from 2 to 16, with a median number of 6; 200 patients were in ward with pharmacists participating in the management and 235 patients in ward without pharmacists participating in the management. One hundred and seventy-nine prescriptions were found with PIM in 435 patients and the incidence of PIM was 41.15%. A total of 280 times of PIM were found in 179 prescriptions. Multivariate logistic regression analysis showed that the number of prescribed drugs (≥5) was an independent risk factor for the occurrence of PIM [odds ratio ( OR)=2.617, 95 % confidence interval ( CI): 1.689-4.054, P<0.001], and the participation of pharmacists in discharge medication management was a protective factor for PIM ( OR=0.673, 95 %CI: 0.457-0.990, P=0.045). Conclusions:The incidence of PIM in discharge prescriptions in elderly patients with stroke was 41.15%. The occurrence of PIM was related to the number of prescribed drugs. Pharmacists′ participation in the management of discharge medications helps to reduce the occurrence of PIM.
