论文部分内容阅读
目的 对美国等8个国家老年人潜在不适当用药(PIM)判断标准进行比较,为制定我国老年人PIM判断标准提供参考. 方法 采用数据库和网络检索方法收集国外已经发布的老年人PIM判断标准,检索时间截至2012年12月.从中选取8个国家的老年人PIM判断标准,主要就标准的制定方法、专家组构成、标准内容等情况进行比较. 结果 纳入分析的为美国、加拿大、日本、法国、挪威、德国、韩国和奥地利等8个国家的老年人PIM判断标准.除美国判断标准已更新至第4版(2012年)外,其余国家均为首次制定.各国标准的适用人群年龄略有差别(≥65～≥75岁).除日本外的其他国家均采用德尔菲法作为研究方法.专家组人员构成有药学人员和老年医学专家、精神科专家、全科/家庭医生等.8个国家的标准在内容和形式上不完全一致,内容主要为3个方面:(1)独立的药物风险;(2)疾病-药物相互作用所致的风险;(3)药物相互作用所致的风险.被标准纳入的药物具有以下特点:(1)老年人使用后易产生毒性和不良反应;(2)老年人使用后风险大于获益;(3)老年人使用后疗效不佳或疗效不确定;(4)可被较安全的同类药物替代. 结论 参考和借鉴国外制定老年人PIM判断标准的方法和经验,有助于早日制定出符合我国国情的老年人PIM判断标准,促进老年人合理用药.,Objective Compare criteria of eight countries such as United States for potentially inappropriate medications (PIM) in elderly,to provide a reference for formulating China’s PIM criteria.Methods Using the database and network,the authors collect the PIM criteria in elderly that has been released from the inception to December 2012.Eight countries PIM criteria were selected and their development method,expert panel’s composition and contents were compared.Results PIM criteria from a total of eight countries including the United States,Canada,Japan,France,Norway,Germany,South Korea and Austria were selected for the analysis.Except the United States PIM criteria has been updated to version 4 (2012),the other countries have just published their first edition.The applicable age of respective country about PIM criteria is slightly different (≥ 65 ～ ≥ 75 years).Seven countries except Japan were using the Delphi method as a research methodology.The composition of the expert panel has pharmacist,geriatrician,psychiatrist,general and family practitioner,and so on.Eight countries’ PIM criteria were not completely consistent in the content and the form,but mainly contain three parts:independent risk factors,drug-disease interactions,and drug-drug interactions.Drugs were included in PIM criteria with the following features:the elderly are prone to poisoning and adverse reactions; the benefits of treatment outweigh its potential risks for the elderly; poor efficacy or uncertain efficacy for the elderly; drugs can be replaced with similar products.Conclusion Reference and leing from foreign method and experience of PIM criteria in elderly can help us to formulate a PIM criteria for China’s situation as early as possible and promote rational use of drugs.