Investigate And Study The Condition Of Off-labled Use Of Drug For Elderly Patients In A Chronic Disease Hospital

Subject:To investigate and analysis the condition of off-label uses of drug for elderly patients in a chronic disease hospital, so as to provide the baseline data for improving the rationality drug use in elderly patients in China.Methods:The prescriptions of elderly patients outpatient department were randomly selected from May 2008 to April 2009; and the off-label use of drug was analyzed according to the package inserts in the following aspects, judged the types of off-label uses, the rate of off-label uses in elderly patients and categories of medicine.Randomly selected 10-bed drug prescriptions of two days a month in this period from Cardiology, endocrinology, gastroenterology, oncology, care center. Judged the ratio of off-label uses of drug in different departments and different types of off-label uses of drug. Analysised the the proportion of off-label uses of drug in adverse drug reactions reported in clinical pharmacy room. The typical clinical efficacy of off-labled drug use was observed.The efficacy of L-carnitine in transient ischemic attack and high dose ambroxol (150mg) in acute exacerbation of bronchial asthma was observed.Result:The total 621 hospitalized senile patient (including 6471 medical order, 349species medicine) and 586 prescriptions of outpatients (including 1636 medical order,2.79 species per formula)were selected. The results of descriptive analysis the about prescriptions of outpatients showed:a) the incidence of off-labled drug use in senile patient is 42.83%; b) the most number of complaint about off-labled drug use is circulatory disease (167,76); the topest incidence of off-labled drug use is antioxidant (91,56.52%); c) the problems such as indication (161,50.63%), dosage (106,33.33%) and concentration (25,7.86%) were the top-three types of off-labled drug use. and drug categories, respectively. The main categories of off-labeled drug use of hospitalized senile patient were dosage (549,47.61%), concentration (342,29.66%). indication (112,9.71%), compatibility (108,9.37%)and so on. The top 2 wards of off-labeled drug use were cordis department (311,26.97%)and secretion department (273,23.68%). The doctors with senior rank prescribed more off-labeled prescriptions than those with intermediate rank. The adverse reaction related with off-labeled drug use occupied 45.16% of the reported adverse reactions. When levocarnitine was off-labeled applied in transient ischemic attack, the total effective rate is 92.31%, but it isn’t statistically significant. When higher dosed ambroxol was applied in bronchial asthma, it can significantly ameliorated the conditions of symptoms and pulmonary function.Conclusion:It is general for the elderly patients in chronic hospital of off-labeled drug use. It is effective ways to reduce the amount of off-labeled drug use and improve drug safety in strict accordance with the instructions provided. It is urgent to develop national laws and regulations or guidelines regulating the behavior of off-labeled drug use to avoid the risk of physician practice. The incidence of off-labeled drug use may also be related to the different habits of different levels doctors. It is higher for senior doctors compared with intermediate grade doctors. It is not statistically significant for senior doctors compared with the deputy high, low and other titles doctors. The off-labeled drug use increases the risk of adverse drug reactions, but some off-labeled drug use can achieve better efficacy without increasing adverse effects, further research is needed.