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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鄭守夏 | zh_TW |
dc.contributor.advisor | Shou-Hsia Cheng | en |
dc.contributor.author | 林筠倩 | zh_TW |
dc.contributor.author | Yun-Chien Lin | en |
dc.date.accessioned | 2023-09-13T16:07:39Z | - |
dc.date.available | 2023-11-09 | - |
dc.date.copyright | 2023-09-13 | - |
dc.date.issued | 2023 | - |
dc.date.submitted | 2023-08-07 | - |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/89625 | - |
dc.description.abstract | 研究背景:老年人因體內組成、藥物吸收和代謝功能改變,加上常有多重共病症和多重用藥的情形,使得他們暴露於藥物不良反應和交互作用的風險。潛在不當用藥是導致老年族群藥物相關問題與不良健康結果的原因之一,造成用藥安全的疑慮。為進一步推動改善老年人用藥適當性的策略,需了解老年病患使用潛在不當用藥的情形與相關的風險因子,然而台灣目前仍缺乏含括各級醫療院所及不同疾病狀況的住院老人,並以2019版Beers criteria分析整體PIM風險及分布情形的研究,使得整體住院老人的用藥適當性無從評估與改善。
研究目的:本研究目的為評估台灣住院老年病患的潛在不當用藥的盛行率,了解常見的潛在不當藥物成分和類別,並分析醫療院所的層級和主診斷之疾病類別與老年人住院期間被處方PIM的風險之關聯性。 研究方法:為橫斷式回溯性觀察型研究,以台灣健保資料庫兩百萬抽樣歸人檔為資料來源,研究對象為2017至2018年間年滿65歲以上、有出入院資料且主診斷之疾病類別符合收案條件的老年病患,每位病患僅納入研究期間第一次住院的資料進行分析。以2019年版Beers criteria評估潛在不當用藥,利用卡方檢定進行雙變項分析;以羅吉斯迴歸分析院所層級和疾病類別對住院病患發生PIM風險之影響,接著以負二項式迴歸分析對住院病患被處方的PIM成分種類數之影響。 研究結果:共收案80036人,結果顯示住院老人於住院時被處方至少一種潛在不當用藥的盛行率為55.3%,最常見的PIM藥物依序為 Benzodiazepines類(鎮靜安眠作用)、Metoclopramide(止吐、調整消化道運動作用)、NSAIDs類(消炎及解熱鎮痛作用)、第一代抗組織胺(止吐、抗動暈及抗過敏作用)、Meperidine(麻醉及鎮痛作用)。迴歸分析顯示,院所層級越低,病患發生潛在不當用藥的風險越高,被處方的PIM成分種類數也較多,相較於醫學中心,區域醫院及地區醫院的病患發生PIM的OR值分別為1.53及1.68 ;區域醫院的病患被處方的PIM種類數比醫學中心多24%,地區醫院比醫學中心多28%,皆達顯著差異(p<0.0001)。主診斷之疾病類別中以「精神、行為和神經發育障礙」的病人發生PIM的風險最高(OR值=6.84),接著依序為「傷害中毒與其他外因造成的影響結果」(OR值=1.24)、「肌肉骨骼系統與結締組織疾病」(OR值=1.23)和「神經系統疾病」(OR值=1.14),相較於參考組(消化系統疾病)皆達統計上的顯著差異,此四類疾病類別之病患被處方的PIM成分種類數皆顯著比參考組的病患多超過10%。 研究結論:台灣的住院老年人有超過一半在住院時被處方潛在不當用藥,且院所層級越低及特定疾病類別的病患,發生的風險及被處方的成分種類數較多的風險也越高。為改善用藥適當性,可提供醫療人員有關PIM及處方優化的教育資訊,並將處方審視和藥物風險效益之評估整合進老年病患的臨床照護中。未來應深入探討處方潛在不當用藥的原因及減少潛在不當用藥的介入措施之成效。 | zh_TW |
dc.description.abstract | Background: The elderly face increased risks of adverse drug reactions and interactions due to age-related changes in body composition, drug absorption, metabolism, and the presence of multiple comorbidities and polypharmacy. Potentially inappropriate medication (PIM) contributes to medication-related issues and adverse health outcomes in the elderly, raising concerns about medication safety. However, there is a lack of large-scale database analysis on hospitalized older adults from various hospital levels and different disease conditions in Taiwan. Additionally, there is a lack of research analyzing the overall PIM risk and distribution using the 2019 Beers criteria.This hinders assessing and improving overall medication appropriateness for hospitalized older adults.
Objective: This study aimed to evaluate the prevalence of PIM use among elderly inpatients in Taiwan, identify commonly prescribed PIM drug classes and medications, and analyze the associations between hospital levels, disease category of primary diagnoses, and the risk of PIM use during hospitalization. Methods: This retrospective cross-sectional study utilized the Longitudinal Generation Tracking Database of National Health Insurance Research Database. This study included elderly inpatients aged 65 and above with hospitalization records between January 1, 2017-December 31, 2018 and primary diagnoses meeting the inclusion criteria. Only data from the first hospitalization during the study period were analyzed. PIMs were assessed using the 2019 Beers criteria, and chi-square tests were performed for bivariate analysis. Logistic regression was used to analyze the associations between hospital levels, disease category of primary diagnoses, and the occurrence of PIM use among hospitalized patients. Negative binomial regression was used to analyze the association between the independent variable and the number of prescribed PIMs. Results: Of 80,036 included patients, 44,234 (55.3%) were prescribed at least one PIM during hospitalization. The most commonly prescribed PIM classes were Benzodiazepines (sedative and hypnotic effects), Metoclopramide(antiemetic and gastrointestinal regulatory effects), NSAIDs(anti-inflammatory and antipyretic analgesic effects), first-generation antihistamines(antiemetic, anti-motion sickness, and antiallergic effects), and Meperidine(anesthetic and analgesic effects). Regression analysis showed that lower-level hospitals were associated with a higher risk of PIM use among elderly inpatients, as well as a higher number of PIMs prescribed. Compared to medical centers, the odds ratios for PIM occurrence were 1.53 for regional hospitals and 1.68 for local hospitals. Patients in regional hospitals had 24% more PIMs prescribed number than those in medical centers, while patients in local hospitals had 28% more PIMs prescribed, with both statistically significant (p<0.0001). Among the disease category of primary diagnosis, patients with " Mental, behavioral, and neurodevelopmental disorders " had the highest risk of PIM use (OR=6.84), followed by " Injury, poisoning, and certain other consequences of external causes " (OR=1.24), "Musculoskeletal system and connective tissue diseases" (OR=1.23), and "Nervous system diseases" (OR=1.14). Patients in these categories also had significantly more PIMs prescribed number, exceeding 10% more than the reference group (Digestive system diseases). Conclusion: Over half of the elderly inpatients in Taiwan were prescribed PIMs during their hospital stay. The risk of PIM occurrence and the number of PIMs prescribed were higher in lower-level hospitals and specific disease categories. To improve medication appropriateness for hospitalized older adults, it is crucial to provide healthcare professionals with education on PIMs and deprescribing. Integrating medication review and risk-benefit evaluation of medication into the clinical care of elderly inpatients is recommended. Future research should further investigate the reasons for PIM being prescribed and evaluate the effectiveness of interventions to reduce the use of potentially inappropriate medication in hospitalized older adults. | en |
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dc.description.provenance | Made available in DSpace on 2023-09-13T16:07:39Z (GMT). No. of bitstreams: 0 | en |
dc.description.tableofcontents | 謝辭 I
中文摘要及關鍵字 II Abstract IV 目錄 VI 表目錄 IX 圖目錄 XI 第一章 緒論 1 第一節 研究動機與背景 1 第二節 研究問題與目的 4 第二章 文獻探討 5 第一節 老年人的用藥風險與品質 5 一、老年人的用藥 5 二、處方的適當性(Appropriateness of prescribing) 7 第二節 潛在不當用藥 8 第三節 潛在不當用藥準則 11 第四節 醫療品質理論架構 15 第五節 台灣潛在不當用藥相關研究 18 第六節 住院老年人潛在不當用藥相關研究 24 第七節 住院老年病患的潛在不當用藥風險 30 第三章 研究設計與方法 33 第一節 研究架構及研究假說 33 一、研究架構 33 二、研究假說 34 第二節 研究資料 35 一、研究對象 35 二、資料來源 35 三、資料內容 36 四、以ATC碼藥檔辨識潛在不當用藥 37 第三節 變項及測量 38 一、潛在不當用藥評估 38 二、疾病之診斷 39 三、共病症指數 40 四、研究變項 40 第四節 資料處理及樣本選取流程 49 第五節 統計分析 53 一、描述性統計 53 二、推論性統計 53 第四章 研究結果 54 第一節 研究對象基本特性及住院潛在不當用藥情形之分布 54 一、研究對象基本特性之分布 54 二、住院期間被處方Beers criteria表列之潛在不當用藥 58 第二節 研究變項與有無潛在不當用藥之雙變項分析 64 一、自變項 64 二、控制變項 65 第三節 院所層級及疾病類別與有無被處方PIM之影響 71 一、院所層級 71 二、主診斷之疾病類別 71 第四節 院所層級及疾病類別與有無被處方PIM之影響-分層分析 76 一、依是否有外科手術-羅吉斯迴歸分層分析 76 二、依院所層級-羅吉斯迴歸分層分析 77 第五節 院所層級及疾病類別與被處方PIM成分種類數之影響-負二項式迴歸 82 一、院所層級 82 二、主診斷之疾病類別 82 第五章 討論 86 第一節 結果與假說驗證 86 第二節 潛在不當用藥情形之討論 88 一、潛在不當用藥之盛行率 88 二、常見的潛在不適當用藥 90 第三節 潛在不當用藥的風險因子之討論 94 一、醫療院所層級 94 二、主診斷之疾病類別 95 三、其他風險因子 97 第四節 研究限制 99 第六章 建議與結論 100 一、健康照護政策建議 100 二、未來研究建議 101 三、結論 101 參考文獻 102 附錄 117 表目錄 表 2-1 台灣潛在不適當用藥相關文獻整理 21 表 2-2 住院老年病患潛在不適當用藥盛行率及風險因子相關文獻整理 27 表 3-1 研究變項操作型定義彙整 45 表 4-1 研究對象基本特性分布情形 59 表 4-2 研究對象主診斷疾病類別之分布情形 61 表 4-3 研究對象於住院期間被處方潛在不當用藥之分布情形 61 表 4-4 研究對象於住院期間的藥物處方為潛在不當用藥之分布情形 62 表 4-5 研究對象住院期間被處方的PIM成分種類數之分布情形 62 表 4-6 研究樣本最常被處方的Beers criteria表列之潛在不當藥物成分 62 表 4-7 研究樣本最常被處方的Beers criteria表列之潛在不當藥物類別 63 表 4-8 自變項與有無被處方潛在不當用藥之相關性-雙變項分析 68 表 4-9 控制變項與有無被處方潛在不當用藥之相關性-雙變項分析 69 表 4-10 研究自變項與有無被處方潛在不當用藥之羅吉斯迴歸分析 73 表 4-11 控制變項與有無被處方潛在不當用藥之羅吉斯迴歸分析 74 表 4-12 研究自變項與有無PIM之羅吉斯迴歸分層分析-依有無外科手術 79 表 4-13 主診斷之疾病類別與有無PIM之羅吉斯迴歸分層分析-依院所層級 80 表 4-14 研究自變項與被處方PIM成分種類數之負二項式迴歸分析 83 表 4-15 控制變項與被處方PIM成分種類數之負二項式迴歸分析 84 附錄表目錄: 附錄表 1 2019版Beers criteria: 大部分老年人應避免使用的PIM 117 附錄表 2 2019版Beers criteria: 患有特定疾病/症候群的老人應避免使用的PIM 126 附錄表 3 2019版Beers criteria: 具有強抗膽鹼作用的藥物 131 附錄表 4 本研究使用2019版Beers criteria判別潛在不當用藥之標準 132 附錄表 5 疾病/診斷對應之國際疾病分類ICD-10-CM代碼一覽 146 附錄表 6 研究樣本前15項常見主診斷之分布 150 附錄表 7 住院期間前三十項常見的PIM成分之分布 152 附錄表 8 各院所層級之住院老年病患常被處方的PIM成分 153 附錄表 9 各院所層級之住院老年病患常被處方的PIM藥物類別 154 附錄表 10 各疾病類別之住院老年病患常被處方的PIM成分 155 附錄表 11 各疾病類別之住院老年病患常被處方的PIM藥物類別 157 附錄表 12 有/無經過外科手術之住院老年病患常被處方的PIM成分 159 附錄表 13 有/無經過外科手術之住院老年病患常被處方的PIM藥物類別 159 附錄表 14 控制變項與有無PIM之羅吉斯迴歸分層分析-依有無外科手術 160 附錄表 15 控制變項與有無被處方PIM之羅吉斯迴歸分層分析-依院所層級 163 附錄表 16 部分控制變項調整分組後的分布情形 166 附錄表 17 部分控制變項調整分組後與有無被處方PIM之相關性-雙變項分析167 附錄表 18 自變項與有無PIM之羅吉斯迴歸分析(調整分組與參考組) 168 附錄表 19 控制變項與有無PIM之羅吉斯迴歸分析(調整分組與參考組) 169 附錄表 20 自變項與有無PIM之羅吉斯迴歸分層分析-依有無外科手術(調整分組與參考組) 171 附錄表 21 控制變項與有無被處方PIM之羅吉斯迴歸分層分析-依有無外科手術(調整分組與參考組) 173 附錄表 22 主診斷之疾病類別與有無PIM之羅吉斯迴歸分層分析-依院所層級(調整分組與參考組) 176 附錄表 23 控制變項與有無被處方PIM之羅吉斯迴歸分層分析-依院所層級(調整 分組與參考組) 178 附錄表 24 自變項與PIM成分種類數之負二項式迴歸分析(調整分組與參考組) 181 附錄表 25 控制變項與PIM成分種類數之負二項式迴歸分析(調整分組與參考組) 182 圖目錄 圖 2-1 Donabedian Structure- Process- Outcomes醫療品質評估架構 16 圖 3-1 研究架構 34 圖 3-2 樣本篩選資料處理流程 51 圖 3-3 評估潛在不當用藥及分析流程 52 | - |
dc.language.iso | zh_TW | - |
dc.title | 住院老年病患潛在性不當處方及相關因素探討 | zh_TW |
dc.title | Prevalence and Risk Factors of Potentially Inappropriate Medications in Hospitalized Elderly Patients | en |
dc.type | Thesis | - |
dc.date.schoolyear | 111-2 | - |
dc.description.degree | 碩士 | - |
dc.contributor.oralexamcommittee | 蕭斐元;詹鼎正 | zh_TW |
dc.contributor.oralexamcommittee | Fei-Yuan Hsiao;Ding-Cheng Chan | en |
dc.subject.keyword | 潛在不適當用藥,住院老年病人,醫療院所層級,主診斷之疾病類別,2019版Beers criteria, | zh_TW |
dc.subject.keyword | Potential inappropriate medication,hospitalized older adults,level of healthcare facility,Disease categories of primary diagnoses,2019 Beers criteria, | en |
dc.relation.page | 183 | - |
dc.identifier.doi | 10.6342/NTU202303267 | - |
dc.rights.note | 同意授權(限校園內公開) | - |
dc.date.accepted | 2023-08-08 | - |
dc.contributor.author-college | 公共衛生學院 | - |
dc.contributor.author-dept | 健康政策與管理研究所 | - |
顯示於系所單位: | 健康政策與管理研究所 |
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