老年患者可预防的药物相关急诊就诊(DREDp)的发生率和相关因素。

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Parinya Phoemlap, Somratai Vadcharavivad, Khrongwong Musikatavorn, Nutthada Areepium
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引用次数: 0

摘要

背景:老年人到急诊科(ED)就诊的比例很高,而且还在不断增加。虽然老年人急诊服务涉及许多因素,但与药物相关的问题(DRPs)却较少被讨论,而这些问题会使患者病情恶化。本研究通过全面的药物回顾,调查了可预防的药物相关急诊就诊(DREDp)的发生率以及老年急诊患者中药物相关问题的特点:一项横断面研究在一所大学附属三级医院的非创伤急诊室进行。所有年龄在 60 岁及以上、正在服药并到急诊室就诊的成年患者均被纳入研究范围。临床药剂师对每位患者进行了全面的药物审查。根据医生和药剂师的判断,如果患者就诊的主要原因与药物相关性不良反应有关,则将其归类为药物相关性急诊就诊(DRED)。因用药错误导致的药物相关性急诊被归类为可预防的,而其他药物相关性急诊则采用修改后的舒莫克和桑顿标准进行可预防性评估:研究涉及 351 名患者,平均年龄为 75.5 岁(标清 9.3),急诊室就诊患者的男女比例相同。合并症的中位数为五种(IQR 3-6),约半数患者服用十种或十种以上药物。跨学科团队将 43 名患者(12.3%)归类为 DREDp,占 74 例(21.1%)药物相关急诊就诊患者的 58.1%。所有被归类为造成伤害(E 级及以上)的用药错误都发生在 DREDp 组中,约占所有 DREDp 的一半(22 例,51.2%)。约三分之二的药物相关急诊就诊与药物不良事件(ADE)有关,主要涉及抗血栓药物、口服降糖药和抗肿瘤药物。多变量分析表明,根据 STOPP 标准,急诊就诊涉及潜在的不适当药物(PIMs)以及存在多种并发症(六种或六种以上并发症)与 DREDp 显著相关:结论:每十名老年患者中就有一人因可预防的 DRP 而就诊于急诊室。导致急诊室就诊的 DRP 大部分是 ADE。PIMs处方和多种并发症都与DREDp有显著相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevalence and factors associated with preventable drug-related emergency department visits (DREDp) in elderly patients.

Background: The prevalence of emergency department (ED) visits among the elderly is high and increasing. While emergency services for the elderly involve many factors, drug-related problems (DRPs) that can worsen patient conditions are less frequently discussed. This study investigates the prevalence of preventable drug-related ED visits (DREDp) and the characteristics of DRPs in elderly ED patients through a comprehensive medication review.

Methods: A cross-sectional study was conducted at a non-trauma ED of a university-affiliated tertiary-care hospital. All adult patients aged 60 years and older who were on medications and visited the ED were included. A clinical pharmacist conducted comprehensive medication reviews for each patient. Patients were classified as experiencing drug-related ED visits (DRED) if their primary reason for the visit was associated with a DRP, as determined by both the physician and pharmacist. DRPs attributed to medication errors were categorized as preventable, while other DRPs were assessed for preventability using modified Schumock and Thornton criteria.

Results: The study involved 351 patients with a mean age of 75.5 years (SD 9.3) and an equal male-to-female ratio of ED visits. The median number of comorbidities was five (IQR 3-6), with about half of the patients taking ten or more medications. The interdisciplinary team classified 43 patients (12.3%) as DREDp, accounting for 58.1% of the 74 (21.1%) drug-related ED visits. All medication errors categorized as causing harm (level E and higher) occurred within the DREDp group, constituting approximately half of all DREDp (22 cases, 51.2%). Approximately two-thirds of drug-related ED visits were associated with adverse drug events (ADEs), predominantly involving antithrombotics, oral hypoglycemic agents, and antineoplastics. Multivariable analysis identified that ED visits involving potentially inappropriate medications (PIMs) according to the STOPP criteria and the presence of multiple comorbidities (six or more concurrent diseases) were significantly associated with DREDp.

Conclusions: About one in ten elderly patients visited the ED due to preventable DRPs. The majority of DRPs leading to ED visits were ADEs. Both the prescription of PIMs and the presence of multiple comorbidities were significantly associated with DREDp.

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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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