目的：本研究主要目的為探討某醫學中心老年人（大於等於 65 歲）急診就醫時使用潛在不適當藥品 (potentially inappropriate medication, PIM) 之情形與可能預測 因子之探討，分析其預測因子如年齡、性別、就醫次數與共病症等。

 

方法：本研究為回溯性病歷資料分析。納入 2018 年 1 月 1 日至 2019 年 9 月 30 日至本院急診就醫之 65 歲（含）以上患者。依據臺灣 2018 年版本之 Beers Criteria，將患者分為有使用 PIM 和無使用 PIM 兩組。使用 t-test 及 chi-square 分析 兩組基本資料，使用多元邏輯斯迴歸分析使用不適當藥品之預測因子。

 

結果：本研究納入 22,663 患者，其中 463 人 (2%) 有使用 Beers Criteria 之藥品。 2 組患者的基本資料比較顯示有使用 PIM 的患者女性 (64.4% vs. 51.3%) 及 > 85 歲 (22.2% vs. 18.3%) 患者較多，平均的急診就醫次數為 2.2 ± 2.4。Charlson comorbidity index (CCI) 共病症指標所計算的分數為 1.8 ± 1.7。多元邏輯斯迴歸分析結果顯示，有使用 PIM 患者的預測因子為女性 (odds ratio [OR], 1.75; 95% confidence interval [CI] = 1.44–2.12)、急診就醫次數大於 2 次 (OR, 1.83; 95% CI = 1.45–2.31) 及 CCI 分數 > 1 分（2 分及 > 2 分的 OR 分別為 1.66 和 1.51）。

 

結論：老年人急診就醫時有使用 PIM 的盛行率為 2%，使用 PIM 的預測因子為 女性、急診就醫次數 > 2 次、CCI 共病症指標分數 > 1 分。

 

 

Objective: The main purpose of this study is to explore the utilization of potentially inappropriate medication (PIM) among elderly who visited the emergency department in the medical center, and to analyze the possible predictive factors such as age, gender, number of emergency visits and comorbidities.

 

Methods: This study is a retrospective analysis of medical records. Patients aged ≥ 65 years old who visited the emergency department from January 1, 2018 to September 30, 2019 were included. According to the 2018 version of Beers Criteria in Taiwan, patients were divided into two groups: those who used PIMs and those who did not.

 

Results: The study included 22,663 patients, of whom 463 (2%) used Beers Criteria list medication. There were more female patients (64.4% vs. 51.3%) and older than 85 years old (22.2% vs. 18.3%) who used PIM. The average number of emergency visits in patients with PIM was 2.2 ± 2.4. The Charlson comorbidity index (CCI) score is 1.8 ± 1.7. Multivariate logistic regression analysis showed that the predictor factors of patients with PIM were female (odds ratio [OR], 1.75; 95% confidence interval [CI] = 1.44–2.12), number of emergency visits more than 2 times (OR, 1.83; 95% CI =1.45–2.31), and the CCI score was > 1 point (ORs of 2 points are 1.66 and > 2 points are 1.51).

 

Conclusions: The prevalence rate of PIM use was 2% in the current study. The predictor factors were female, the number of emergency medical visits > 2 times, and the CCI comorbidity index score > 1 point.

 

Submited for publication: 2021.6.28; Accepted for publication: 2022.1.3