| Potential Inappropriate Medication(PIM)refers to the potential adverse risks of using certain drug exceeding the expected benefits.It is a high-risk drug.Potentially Inappropriate Prescribing(PIP)includes PIM and PPO(Potentially Inappropriate Omission).The purpose of this study is to formulate PIP standards for elderly patients with endocrine diseases in China,and to conduct empirical research on the obtained standards in order to verify the effectiveness of the standards in the process of medical record review and to analyze the influencing factors of PIP in elderly patients and re-admission.It is mainly divided into the following two parts.Firstly,PIP standards for endocrine diseases and drug use were established based on literature research and Delphi method.METHODS: Literatures on PIP standards for elderly patients from Pubmed,Embase and CNKI self-built databases to January 2018 were retrieved,and a primary standard was formed through screening,extraction,supplementation and integration.The primary criteria were distributed to clinical experts in the form of questionnaires for scoring,and further revised according to the feedback results.RESULTS: A total of 39 PIP items were obtained after initial screening and integration,which were included in the PIP standards of 12 countries and regions.Two rounds of Delphi method were carried out.The recovery rate of the first round questionnaire was 100%.The mean value of opinion concentration degree(Mj)was 4.085±0.414;the mean value of Full Score frequency(Kj)was 0.423 ±0.216;the mean value of variation coefficient(Vj)was 0.240 ±0.0906,and the coordination coefficient(w)was 0.417.,and the tested value of 325.285,P < 0.001.The second round of questionnaires had a recovery rate of 100%.,the mean score was 4.322 ±0.404,the mean full score frequency was 0.508 ±0.218,and the mean coefficient of variation was 0.193 ±0.078.a coordination coefficient of 0.530,and the tested value of 318.473 and a P value of 0.000,the results showed that the expert coordination degree and reliability are high.Finally,a total of 35 PIP standards were established,including 8 potential risk drugs,11 drugs under special disease conditions,9 drug-drug interactions and 7 potential drug omissions.The second part is the empirical study of establishing standards.METHODS: According to the standard of medical records,the elderly patients(> 65 years old)in the Department of endocrinology of Sichuan People's Hospital from March to September 2018 were included.The basic information,disease and medication of the patients were collected.The existing PIP was examined by PIP standard and compared with the existing standards.The influencing factors of PIP and readmission were analyzed by SAS software,and the odds ratios of influencing factors and 95% confidence limit were analyzed.Results: 323 cases were included in the study.Among them,190 cases(58.8%)were female and 133 cases(41.2%)were male;the age range of patients was 66-95 years(average 74.1 years);the length of hospitalization was 4-29 days(average 12.8 days);the number of drugs used by patients ranged from 3 to 46,with an average of 18.7 kinds/case,and 87 cases(26.9%,87/323)used traditional Chinese medicine preparations.The results of medical records review showed that the most common potential inappropriate drug use in elderly endocrine inpatients was potential drug omission: 41 patients with diabetic nephropathy(UACR(> 30 ug/mg)did not receive ACEI or ARB(if ACEI was intolerant),accounting for 74.5%(41/55)of diabetic nephropathy patients,accounting for 12.7%(41/323)of the total number of patients,followed by long-acting sulfonylureas(Gliben).Urea and gliclazide accounted for 11.5%(37/323)of the total number of patients,and glimepiride(6.5%,21/323).Screening results showed that there was at least one potential inappropriate drug use in 137 elderly patients.The incidence of ADR and readmission in elderly patients with PIP were 4.8% and 15.8% respectively,which were higher than the existing standards and showed higher sensitivity.The Logistic regression showed that Charlson Comorbidity Index(OR=1.332,95%CI 1.189~1.492,P<0.0001)and diabetic acute complication(OR=3.341,95%CI 1.339~8.336,P<0.0001)were independent risk factors for PIP.Logistic regression analysis showed that osteoporosis(p=0.028)was an independent risk factor for readmission(OR=1.956,95% CI 1.075-3.560).CONCLUSION: In this study,PIP criteria for elderly patients with endocrine diseases were established by Delphi method.Compared with the existing criteria,PIP criteria are more sensitive and predictable for ADR and readmission,suggesting that clinicians should pay attention to reducing unnecessary and inappropriate medication.For elderly patients with diabetic acute complication and osteoporosis,clinicians should pay more attention to the rationality of drug use and improve the level of drug safety use. |
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