处方前置系统联合药学服务对老年患者药品处方监管的应用及思考

摘要/Abstract

摘要： 目的：为慢病高龄老年人群临床合理用药和处方前置审核规则库精细化、专科化管理提供参考依据。方法：采用单中心回顾性队列研究方法，基于Beers（2023年版）和STOPP/START（第3版）标准评价潜在不适当用药（PIM）和用药遗漏（POMs）的数量、处方药物总数。采用R语言比较临床用药回顾（CMR）组，处方前置审核（PPRs）组和联合药学服务（PPRs+SPC）组间差异。结果：共纳入了180例患者，每组60例，平均年龄83岁，性别比0.41；3组比较入/出院药品PIMs未有减少。与CMR相比，PPRs组药物品种数增加（P=0.04）；PPRs+SPC组入/出院医嘱开出POMs人数显著降低（P<0.05），出院POMs药品数显著降低（P=0.01），出/入院POMs差异减少与开展的处方前置和联合药学服务的活动显著相关（P<0.05）；与PPRs相比，PPRs+SPC组入/出院药品POMs数和POMs人数均得到显著降低（P=0.01）。PPRs+SPC组更多地减少心血管药物相关POMs（P=0.01）。结论：处方前置系统和药学服务并没有减少PIMs的数量，但其可帮助临床医生更好地使用药物，特别是心血管药物，降低已知疾病的进展和死亡风险。

关键词: font-size:medium, ">老年病房；处方前置；药学服务；处方适宜性

Abstract: Objective： To provide a reference for the refined and specialized management of the clinical rational drug use and prescription pre-review rule base in the elderly population with chronic diseases. Methods： A single-center retrospective cohort study was conducted to evaluate the number of potentially inappropriate medications (PIM) and medication omissions (POMs) and the total number of prescription drugs based on the criteria of Beers (2023 edition) and STOPP/START (3rd edition). R language was used to compare the differences between the clinical medication review (CMR) group， the pre-prescription review (PPRs) group， and the combined pharmacy services (PPRs+SPC) group. Results： A total of 180 patients with 60 patients in each group， with an average age of 83 years and a sex ratio of 0.41， were included. Compared with CMR， the number of drug varieties in the PPRs group increased (P=0.04). In the PPRs+SPC group， the number of POMs prescribed by admission/discharge physicians was significantly lower (P<0.05)， the number of drugs discharged from hospital POMs was significantly lower (P=0.01)， and the difference between discharge/admission POMs was significantly correlated with the activities of pre-prescription and combined pharmacy services (P<0.05)； Compared with PPRs， the number of POMs and the number of POMs in the PPRs+SPC group were significantly reduced (P=0.01). The PPRs+SPC group had more reductions in cardiovascular drug-related POMs (P=0.01). Conclusion： Prescribing systems and pharmacy services do not reduce the number of PIMs， but they can help clinicians better use drugs， especially cardiovascular drugs， which may reduce the progression and death of known diseases.

Key words: font-size:medium, ">Geriatric ward；Pre-prescription；Pharmacy services；Prescribing appropriateness ,

中图分类号:

陈家浩, 王世玉, 邹玉, 易文燕, 黎晨辉. 处方前置系统联合药学服务对老年患者药品处方监管的应用及思考[J]. 中国药物评价, 2025, 42(3): 236-240.

CHEN Jiahao, WANG Shiyu, ZOU Yu, YI Wenyan, LI Chenhui. Application and Reflection on the Pre-scription System Combined with Pharmaceutical Services for Supervising Drug Prescriptions in Elderly Patients[J]. CHINESE JOURNAL OF DRUG EVALUATION, 2025, 42(3): 236-240.

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