| Objective:Two sampling methods were used to extract elderly inpatients from a tertiary hospital to identify potential inappropriate medicines(PIM);The differences between different criteria were compared;To compare the differences of different sampling methods in identifying PIM of elderly inpatients,so as to provide reference for the selection of sampling methods;Objective to classify and grade the types and severity of PIM,so as to provide guidance and help for reducing the medication risk of elderly inpatients.Methods:(1)832 cases of elderly inpatients were selected by stratified sampling method.Beers,STOPP/START and Chinese criteria for potentially inappropriate drug use in the elderly(2017 Edition)were used to identify PIM.Kappa test was used to judge the consistency of PIM;(2)The medical records of 831 inpatients were selected by random number table method.Beers,STOPP/START and Chinese standards were used to identify PIM,and Kappa test was used to determine the consistency of PIM;(3)χ~2test,independent sample t test and Kappa test were used to analyze the differences between the two sampling methods;(4)The problems and causes of PIM in 831 inpatients selected by random number table method were classified according to the European pharmaceutical care network(pcne)version 9.0.The National Coordinating Council for medical error reporting and Prevention(ncc-merp)was used to grade the severity of PIM.The risk factors of PIM were analyzed byχ~2test and ordered multiple logistic regression.Results:(1)After stratified sampling,a total of 1511 times,with an average of 1.8 times per patient;Beers standard detected 231 cases,491 times PIM,STOPP/START standard detected400 cases,904 times PIM,Chinese standard detected 340 cases,721 times PIM;The most frequent PIM drugs were aspirin,lidocaine,doxofylline,etc;Kappa test showed that the consistency between Chinese standard and STOPP/START standard(Kappa=0.236,P<0.05),beers standard and STOPP/START standard(Kappa=0.222,P<0.05)was poor;(2)A total of 963 PIMS were detected in elderly inpatients by random number table method,with an average of 1.2 PIMS per patient;Beers standard detected 432 PIMs in 207 cases,STOPP/START standard detected 563 PIMs in 249 cases,and Chinese standard detected 571PIMs in 291 cases;The most frequent PIM drugs were doxofylline,alprazolam,methylprednisolone,aspirin,etc;Kappa test showed that the consistency between Chinese standard and STOPP/START standard(Kappa=0.234,P<0.05),beers standard and STOPP/START standard was poor(Kappa=0.227,P<0.05);(3)After comparing the two sampling methods,the age(χ~2=17.130,P<0.05),length of stay(χ~2=21.224,P<0.05),number of diseases(χ~2=25.117,P<0.05)were statistically significant,while methylprednisolone(t=16.311,P<0.05),lidocaine(t=3.455,P<0.05)and doxofylline(t=-3.806,P<0.05)were significantly different,The PIM frequency identified by the two sampling methods was significantly different(t=6.424,P<0.05),and the consistency between the two sampling methods was poor(Kappa=0.276,P<0.05);(4)Pcne showed that the most common problem was treatment safety,accounting for 88.2%of all PIM problems.The most common cause of PIM was drug selection,accounting for 90.6%of PIM problems;Ncc-merp showed that 96.9%of PIMS were graded B,and 3.1%were graded C to F;Univariate and multivariate analysis showed that the number of drugs(OR=0.024,95%Cl0.037-0.131,P<0.05)and the number of diseases(OR=0.023,95%Cl 0.002-0.090,P<0.05)were independent risk factors for PIM.Conclusion:(1)Both sampling methods showed that PIM was common in elderly inpatients;(2)The three standards should learn from each other and be updated regularly;(3)It is necessary to consider the purpose of the study,the disease and the drug use of the Department;(4)The classification system can provide active and targeted pharmaceutical care measures.In order to improve the medication safety of elderly patients,we should focus on the elderly patients suffering from multiple diseases and multiple drug use,so as to improve the drug treatment of patients. |
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