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目的了解多药合用的老年患者治疗药物的合理使用情况,和药师在治疗团队中的作用。方法符合纳入标准的老年患者182人,男性58人,女性124人;平均年龄71.1岁。由药师、医师和护士组成的治疗团队对患者的用药情况进行审核,每位患者面对面的用药指导和教育时间不少于30min,6周后随访了解干预效果。结果共发现药物相关问题643条(平均每位患者3.5条),涉及的药物数为608个,主要问题是无适应证用药177条(25.73%);有用药适应证但没有用药43条(6.69%)和诊断不明确的95条(14.77%)共计315条(43.19%)。干预后,接受建议的共计339条(停药160条,更改152条,新增药物27条),患者的平均用药数从6.54条减为5.81条,干预前后差异有非常显著性(P<0.01)。结论老年患者用药存在较多不合理使用问题,药师在治疗团队中发挥重要作用。
Objectives To understand the rational use of therapies in elderly patients with multi-drug use and their role in the treatment team. Methods A total of 182 elderly patients, including 58 males and 124 females, were included. The average age was 71.1 years. A team of pharmacists, physicians, and nurses reviewed the patient’s medication status. Each patient had face-to-face medication guidance and education for at least 30 minutes. Follow-up was followed up for 6 weeks to understand the effect of the intervention. Results A total of 643 drug-related problems (average 3.5 per patient) were found. The number of drugs involved was 608, with the main problems being 177 without indications (25.73%), 43 with medication indications without medication (6.69 %) And undefined 95 (14.77%) were 315 (43.19%). After the intervention, a total of 339 recommendations (160 discontinuation, 152 changes, 27 new drugs) were taken and the average number of patients was reduced from 6.54 to 5.81, with significant differences between before and after intervention (P <0.01 ). Conclusion There are a lot of unreasonable use problems in elderly patients, and pharmacists play an important role in the treatment team.