| Objective:(1)To research the medication situation of elderly patients with chronic diseases in Taiyuan City,and to find out the influencing factors of potential inappropriate medication(PIM)in elderly patients with chronic diseases,in order to reduce the incidence of PIM in elderly patients with chronic diseases in the community;(2)To evaluate the current situation of health-related quality of life(HRQOL)of elderly patients with chronic diseases in Taiyuan City,and to explore the factors affecting HRQOL;(3)To study the influence of potential inappropriate drug use on health-related quality of life,and to provide reference for clinical rational drug use and making health-related policies for the elderly.Methods:Taking the elderly chronic disease patients(age?60 years old)in Taiyuan city community as the research object,10 community health service centers were selected by multi-stage random sampling method,50 people were selected from each community health service center,and a total of 500 people were selected for household visit survey.According to the 2015 Beers criteria,PIM of elderly patients with chronic diseases in Shanxi community was screened,and the health-related quality of life was evaluated with the European five-dimensional Health Questionnaire(EQ-5D).The general characteristics,health status of each dimension and health-related quality of life of the respondents were analyzed by percentage,mean±SD.The incidence of PIM was tested by?~2 tests.The influencing factors of PIM were analyzed by logistic regression model.The scores of EQ-5D index and EQ-VAS were analyzed by Wilcoxon rank sum test(or Kruskal Wallis H test);the influencing factors of each dimension with problems were analyzed by logistic regression,EQ-5D index and EQ-VAS score by multiple linear regression analysis.Results:Based on the 2015 Beers criteria,among 476 elderly patients with chronic diseases,320(67.23%)had potential inappropriate medication.Among them,105 cases(32.81%)had potential inappropriate medication related to drugs,the most frequent drugs were nifedipine,insulin,non cyclooxygenase(COX)selective non steroidal anti-inflammatory drugs(NSAIDs),etc.;55 cases(17.18%)had potential inappropriate medication related to disease status,The first two drugs of PIM are most likely to occur:Aspirin(>325mg/d)related to the history of gastric ulcer or duodenal ulcer and NSAIDs related to the Creatinine clearance(CrCl)<30ml/min in stage 4 and below of chronic kidney disease;63 cases(19.69%)of the elderly patients used the potential inappropriate medication that should be carefully used,of which the most frequent use of diuretics,followed by aspirin for the first-line prevention of cardiovascular events in the elderly over 80 years old;There are 5 groups of non anti infective drug interactions that should be avoided,mainly including warfarin and other drugs with increased risk of bleeding,and ACEIs with drugs with increased risk of hyperkalemia;in CrCl<30 ml/min,10 cases(3.13%)of non anti infective drugs should be avoided or reduced as much as possible based on renal function.Spironolactone is the most likely drug for PIM.Logistic regression analysis found that the more the number of combination drugs,the older the risk of PIM is higher.(2)The scores of EQ-5D index and EQ-VAS were(0.79±0.20)and(71.31±13.63)respectively.Multiple linear regression analysis showed that marital status,total number of patients,duration of disease,potential inappropriate drug use,drinking and drug compliance were the influencing factors of EQ-5D index(P<0.05).The influencing factors of EQ-VAS were the total number of patients,the time of illness,the compliance of medication and drinking(P<0.05).Conclusion:in Taiyuan community,the incidence of potential inappropriate medication is high,and the comprehensive score of quality of life is low.The number of combined drugs and the total number of patients are the primary factors to increase the incidence of potential inappropriate medication,and potential inappropriate medication is an important influencing factor of quality of life.Community pharmacists should combine the epidemiological characteristics and clinical medication characteristics of local patients,draw on and use various standards reasonably,pay attention to drug interaction,remind doctors and patients to use all kinds of drugs specified by Beers carefully,reduce the risk of medication for the elderly,promote rational medication for the elderly,and improve the quality of life of elderly patients with chronic diseases. |
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