居家照護老年病患潛在性不適當處方相關因子之研究

研究背景：台灣人口急速老化，失能人口增加，對居家照護之需求與日俱增。本篇研究目的：分別使用STOPP (the Screening Tool of Older Persons’ potentially inappropriate Prescriptions)及Beers 2012準則兩種工具，評估居家照護老年人，瞭解其潛在性不適當處方的情況。研究方法：研究對象為141位超過65歲，巴氏量表(Barthel scale)分數低於60分，接受居家照護之老年病患。他們從2012年7月至12月間，在中山醫學大學附設醫院，規則拿慢性病處方簽。詳盡回顧病歷紀錄來獲得完整的病人資料。分別使用STOPP及Beers 2012準則，做為潛在性不適當處方 (potentially inappropriate medication, PIM) 的評估工具。使用邏輯斯迴歸分析(Logistic regression)，找出 PIM 的危險因子。使用約登指数(Youden index)得到預測 PIM，其藥物數目之最佳切分點。研究結果：共141位居家照護患者，分別使用STOPP及Beers 2012準則，PIM的盛行率為94(66.7%)比94(66.7%)。多變項分析，使用Beers 2012準則發現：PIM 與多重藥物處方(p = 0.013)及身心疾病有相關(p < 0.001)；使用STOPP準則發現：PIM 與多重藥物處方相關(p = 0.008)。使用STOPP及Beers 2012準則來預測 PIM，藥物數目的最適切分點為6種；校正共變項(Covariate)後，處方6種(含)藥物相較少於6種藥物，有顯著較高的風險，會產生 PIM (兩者p < 0.05)。 結論：本研究發現，嚴重失能的老年居家照護患者，是發生 PIM 的高風險族群，開立大於或等於6種藥物處方，更會增加 PIM 的風險。

Background: The impact of rapid aging with an increasingly disabled population and the demand for home care is rising in Taiwan. The goal of this study is to evaluate the prescription of potentially inappropriate medications (PIM), using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) and Beers 2012 criteria, to the elder receiving home care.Methods and Materials: One hundred and forty-one patients aged ≥ 65 years with Barthel scale scores ≤ 60 receiving home care were enrolled. They regularly take long-term (≥ 28 days) prescriptions for chronic diseases at Chung Shan Medical University Hospital from July to December 2012. Comprehensive patient information was produced from the patients’ medical notes. The STOPP and Beers 2012 criteria were used separately to identify PIM, and logistic regression analyses were performed to identify risk factors for PIM. The optimal cutoff for the number of medications prescribed for predicting PIM was estimated using the Youden index. Results: Of the 141 patients receiving home care, 94 (66.7%) and 94 (66.7%) had at least one PIM identified by the STOPP and Beers criteria, respectively. In multivariate analysis, PIM identified by the Beers criteria were associated with the prescription of multiple medications (p = 0.013) and the presence of psychiatric diseases (p < 0.001), whereas PIM identified by the STOPP criteria were only associated with the prescription of multiple medications (p = 0.008). The optimal cutoff for the number of medications prescribed for predicting PIM by using the STOPP or Beers criteria was 6. After adjustment for covariates, patients prescribed ≥ 6 medications had a significantly higher risk of PIM, identified using the STOPP or Beers criteria, compared to patients prescribed <6 medications (both p < 0.05). Conclusion: This study revealed a high frequency of PIM in disabled older patients with home care, particularly those prescribed ≥ 6 medications.