您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (7): 75-81.doi: 10.6040/j.issn.1671-7554.0.2024.1233

• 公共卫生与预防医学 • 上一篇    下一篇

山东省农村地区多重慢病患者潜在不适当用药情况

张茗语1,2,高士娟1,2,潘东杰1,2,王春霞3,王海鹏1,2,李慧1,2   

  1. 1.山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心, 山东 济南 250012;2.国家卫生健康委员会卫生经济与政策研究重点实验室(山东大学), 山东 济南 250012;3.山东第一医科大学附属中心医院, 山东 济南 250013
  • 发布日期:2025-07-08
  • 通讯作者: 李慧. E-mail:huili@sdu.edu.cn
  • 基金资助:
    美国中华医学基金会资助项目(18-298);国家重点研发计划(2020YFC2006500,2020YFC2006505);潍坊市政府采购项目(2024WF03)

Potentially inappropriate medication of patients with multiple chronic diseases in rural areas of Shandong Province

ZHANG Mingyu1,2, GAO Shijuan1,2, PAN Dongjie1,2, WANG Chunxia3, WANG Haipeng1,2, LI Hui1,2   

  1. 1. Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan 250012, Shandong, China;
    3. Centre Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong, China
  • Published:2025-07-08

PDF (PC)

43

摘要： 目的 探索农村地区多重慢病患者多重用药以及潜在不适当用药(potentially inappropriate medication, PIM)的现状和影响因素,比较2023版Beers标准(以下简称“Beers标准”)和《中国老年人潜在不适当用药判断标准(2017版)》(以下简称“中国标准”)两种标准评价PIM的异同及适用性,为降低农村地区多重慢病患者PIM发生率提供证据支持。 方法 采用多阶段随机抽样的方法选取山东省16个村531例多重慢病患者,以问卷方式调查用药情况;以Beers标准和中国标准对患者PIM情况进行评估分析;采用多因素Logistics回归分析患者PIM的风险因素;采用Kappa检验评估结果的一致性。 结果 参照Beers标准,共有390例患者存在PIM;参照中国标准,共有312例患者存在PIM。两种标准识别的主要风险药物为利血平、阿司匹林、硝苯地平等常用药品;二分类Logistic回归分析结果显示,性别和用药种类数是患者发生PIM的影响因素(P<0.05),评估PIM一致性系数为0.179;将利血平加入2023版Beers标准后,两种标准的一致性系数为0.369。 结论 山东省农村地区多重慢病患者PIM情况较严重。建议在临床中联合使用两种标准以提高识别准确性,并建立健全中成药PIM识别体系。

关键词: 农村地区, 多重慢病, 潜在不适当用药, Beers标准

Abstract: Objective To explore the current status and influencing factors of polypharmacy and potentially inappropriate medication(PIM)among patients with multimorbidity in rural areas, and to compare the differences and applicability of the 2023 Beers Criteria(hereinafter referred to as the "Beers Criteria")and the Chinese Criteria for Potentially Inappropriate Medications in Older Adults(2017 Edition)(hereinafter referred to as the "Chinese Criteria")in PIM evaluation, with the aim of providing evidence for reducing PIM incidence in this population. Methods A multi-stage random sampling method was used to select 531 multimorbid patients from 16 villages in Shandong Province. Medication use was investigated via questionnaire surveys, and PIM was assessed using both the Beers Criteria and the Chinese Criteria. Multivariate Logistic regression was performed to identify risk factors for PIM, and the Kappa test was employed to evaluate consistency between the two criteria. Results According to the Beers Criteria, 390 patients had PIM, while the Chinese Criteria identified 312 cases. Both criteria highlighted high-risk medications such as reserpine, aspirin, and nifedipine. Multivariate Logistic regression revealed that gender and the number of medications were significant influencing factors for PIM(P<0.05). The consistency coefficient(Kappa)between the two criteria was 0.179; however, after incorporating reserpine into the Beers Criteria, the consistency improved to 0.369. Conclusion PIM is prevalent among rural patients with multimorbidity in Shandong Province. We recommend combining both criteria in clinical practice to enhance PIM detection accuracy and establishing a systematic PIM identification framework for traditional Chinese patent medicines.

Key words: Rural area, Multiple chronic diseases, Potentially inappropriate medication, Beers standard

中图分类号: 

  • R197.62
[1] 郑晓, 张持晨, 田峰, 等. 社区中老年人多重慢病健康管理服务路径研究[J]. 中国全科医学, 2024, 27(17): 2119-2123. ZHENG Xiao, ZHANG Chichen, TIAN Feng, et al. Study on the health management service pathway for multimorbidity of middle-aged and older adults in the community[J]. Chinese General Practice, 2024, 27(17): 2119-2123.
[2] 鲍欣雨, 谢易娴, 张晓霞, 等. 多重慢病对社区居民健康相关生命质量的影响分析[J]. 中国卫生经济, 2019, 38(3): 74-77. BAO Xinyu, XIE Yixian, ZHANG Xiaoxia, et al. Analysis on the effects of multimorbidity on health-related quality of life of community residents[J]. Chinese Health Economics, 2019, 38(3): 74-77.
[3] Scottish Government Polypharmacy Model of Care Group. Polypharmacy guidance, realistic prescribing(3rd ed)[EB/OL].(2018-04-02)[2024-10-20]. https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance2018
[4] 王清理, 卫永丽, 裴媛, 等. 依据Beers标准评价老年患者不合理用药[J]. 药物流行病学杂志, 2014, 23(12): 722-724. WANG Qingli, WEI Yongli, PEI Yuan, et al. Evaluation of elderly outpatients irrational drug use by beers criteria[J]. Chinese Journal of Pharmacoepidemiology, 2014, 23(12): 722-724.
[5] 王春霞, 贺梦璐, 王海鹏, 等. 山东省农村地区多重慢病患者多重用药现状及影响因素分析[J]. 山东大学学报(医学版), 2022, 60(1): 93-100. WANG Chunxia, HE Menglu, WANG Haipeng, et al. Prevalence and influencing factors of polypharmacy in multimorbidity patients in rural areas of Shandong Pro-vince[J]. Journal of Shandong University(Health Sciences), 2022, 60(1): 93-100.
[6] 张倩, 李沭, 李朋梅. 美国老年医学会老年人潜在不适当用药Beers标准2023版解读[J]. 中国全科医学, 2023, 26(35): 4372-4381. ZHANG Qian, LI Shu, LI Pengmei. Interpretation of the 2023 AGS beers criteria: potentially inappropriate medication use in older adults[J]. Chinese General Practice, 2023, 26(35): 4372-4381.
[7] 中国老年保健医学研究会老年合理用药分会. 中国老年人潜在不适当用药判断标准(2017年版)[J]. 药物不良反应杂志, 2018, 20(1): 2-8.
[8] 程素丹, 祝军峰, 王臣大. 基于Beers标准和STOPP/START标准评价住院老年患者的潜在不适当用药及其影响因素[J]. 中国现代医生, 2022, 60(34): 78-82. CHENG Sudan, ZHU Junfeng, WANG Chenda. Evaluation of potentially inappropriate medication and its influencing factors in geriatric patients based on Beers and STOPP/START criteria[J]. China Modern Doctor, 2022, 60(34): 78-82.
[9] 李薇, 唐亚娟, 张琰, 等. 基于Beers标准(2019版)及中成药点评标准评价某院老年患者不适当用药[J]. 中国药物与临床, 2021, 21(20): 3464-3468. LI Wei, TANG Yajuan, ZHANG Yan, et al. Evaluation of inappropriate drug use for elderly patients in a hospital based on Beers standard(2019 edition)and Chinese patent medicine review standard[J]. Chinese Remedies & Clinics, 2021, 21(20): 3464-3468.
[10] 舒冰, 方玉婷, 李民, 等. 老年多重用药患者潜在不适当用药情况及其影响因素研究[J]. 中国全科医学, 2021, 24(17): 2134-2139, 2147. SHU Bing, FANG Yuting, LI Min, et al. Evaluation of potentially inappropriate medication in elderly patients with multiple medications[J]. Chinese General Practice, 2021, 24(17): 2134-2139, 2147.
[11] 国家卫生计生委合理用药专家委员会,中国医师协会高血压专业委员会. 高血压合理用药指南(第2版)[J]. 中国医学前沿杂志(电子版), 2017, 9(7): 28-126.
[12] 林丽芬, 陈沭, 卢燕辉, 等. 某院2020—2022年门诊药房非甾体抗炎药的用药分析[J]. 中国药物评价, 2024, 41(4): 327-330. LIN Lifen, CHEN Mu, LU Yanhui, et al. Medication analysis of non-steroidal anti-inflammatory drugsin outpatient pharmacies of a hospital from 2020 to 2022[J]. Chinese Journal of Drug Evaluation, 2024, 41(4): 327-330.
[13] 王嘉熙, 孔祥豪, 郭代红, 等. 5 597例非甾体抗炎药的不良反应报告分析[J]. 药物流行病学杂志, 2021, 30(7): 457-461. WANG Jiaxi, KONG Xianghao, GUO Daihong, et al. Analysis of 5597 reports of adverse reactions to NSAIDs[J]. Chinese Journal of Pharmacoepidemiology, 2021, 30(7): 457-461.
[14] 孙成昊. 高龄住院患者潜在不适当用药情况分析[D]. 长春: 吉林大学, 2023.
[15] 李燕华, 李仲昆, 夏洪颖, 等. 三种常用的老年人潜在不适当用药评估标准的比较[J]. 中国医药导报, 2020, 17(33): 165-169. LI Yanhua, LI Zhongkun, XIA Hongying, et al. Comparison of three commonly used evaluation criteria for potentially inappropriate medication in elderly[J]. China Medical Herald, 2020, 17(33): 165-169.
[16] 樊萍萍, 陆蕾, 刘小燕. Beers标准(2019)评估老年多重用药患者潜在不适当用药的价值[J]. 实用药物与临床, 2024, 27(1): 5-9. FAN Pingping, LU Lei, LIU Xiaoyan. Beers criteria(2019)to evaluate the potentially inappropriate medication in elderly patients with multiple use of drugs[J]. Practical Pharmacy and Clinical Remedies, 2024, 27(1): 5-9.
[17] 吴运同, 许甜甜. 中成药在某院慢性非传染性疾病治疗中的使用情况分析[J]. 中国医院用药评价与分析, 2023, 23(4): 485-487. WU Yuntong, XU Tiantian. Application of Chinese patent medicine in the treatment of non-communicable chronic disease in a hospital[J]. Evaluation and Analysis of Drug-Use in Hospitals of China, 2023, 23(4): 458-487.
[18] 徐敢, 罗卫花, 王玉伟, 等. 中成药防治重大慢性病的药物经济学评价体系构建[J]. 中国药房, 2022, 33(17): 2060-2064. XU Gan, LUO Weihua, WANG Yuwei, et al. Construction of the pharmacoeconomic evaluation system of Chinese patent medicine in the prevention and treatment of major chronic diseases[J]. China Pharmacy, 2022, 33(17): 2060-2064.
[19] 金锐, 赵奎君, 郭桂明, 等. 中成药临床合理用药处方点评北京共识[J]. 中国中药杂志, 2018, 43(5): 1049-1053. JIN Rui, ZHAO Kuijun, GUO Guiming, et al. Expert consensus on prescription comment of Chinese traditional patent medicine for promoting the rational use of drugs in Beijing[J]. China Journal of Chinese Materia Medica, 2018, 43(5): 1049-1053.
[20] 陈光, 傅锐良, 周京辉, 等. 感冒类中成药处方点评标准制定在促进临床合理用药中的价值[J]. 中国处方药, 2023, 21(3): 78-81. CHEN Guang, FU Ruiliang, ZHOU Jinghui, et al. The value of formulating criteria for the review of prescriptions of proprietary Chinese patent medicines for colds and flu in promoting rational clinical use of medicines[J]. Journal of China Prescription Drug, 2023, 21(3): 78-81.
[21] 邱奕榕, 孙冰婷, 顿文亮. 常用潜在不适当用药筛查标准联合自拟中药判断标准评估分析老年住院患者潜在不适当用药[J]. 医药导报, 2024, 43(1): 126-130. QIU Yirong, SUN Bingting, DUN Wenliang. Application of commonly-used PIM screening criteria combined with self-developed traditional Chinese medicine PIM criteria to evaluate potentially inappropriate medication in elderly inpatients[J]. Herald of Medicine, 2024, 43(1): 126-130.
[1] 王春霞,贺梦璐,王海鹏,李慧. 山东省农村地区多重慢病患者多重用药现状及影响因素分析[J]. 山东大学学报 (医学版), 2022, 60(1): 93-100.
[2] 国雪杰,杨孝荣,桑少伟,刘兵艳,吕明. 济南市平阴县农村成年居民高血压知晓现状及影响因素[J]. 山东大学学报 (医学版), 2019, 57(12): 103-109.
[3] 朱建雷,刘金同,王旸,王端卫,朱晓萌,张珊静,朱建伟. 枣庄市农村留守儿童主观生活质量与自我意识现状[J]. 山东大学学报（医学版）, 2017, 55(9): 128-132.
[4] 林少倩1，何丕山2，李军1，刘大聪3，高莉洁1，贾兴兵4，李慧1，刘冬梅1，王志萍1. 山东省3县农村地区儿童超重肥胖的影响因素分析[J]. 山东大学学报(医学版), 2012, 50(6): 125-.
[5] 范雷1，鹿子龙2，楚洁2，马吉祥2，孙晓筠3，黄帅1，董静2，郭晓雷2，张吉玉2. 山东省中西部地区农村居民血压综合干预效果分析[J]. 山东大学学报(医学版), 2012, 50(2): 145-.
[6] 廉颖1，贾存显1，邱惠敏2，张吉玉3，刘慧1，韩梅1. 服农药自杀未遂者社会心理学和自杀行为的特征[J]. 山东大学学报(医学版), 2012, 50(11): 113-.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发