应用Rodgers演化概念分析法界定多重用药

doi:10.16460/j.issn1008-9969.2023.17.039

摘要/Abstract

摘要： 目的运用Rodgers演化概念分析法界定多重用药,为识别患者合理用药情况,避免潜在用药错误提供理论基础。方法系统检索中国知网、万方数据、维普网、PubMed、Web of Science和CINAHL数据库。搜索时限为建库至2023年2月。根据纳入标准最终选取54篇文献,以Rodgers演化概念分析法为理论指导对多重用药进行分析界定。结果多重用药涉及3个概念属性：药物联合治疗性、潜在的不适当用药性、用药决策复杂性;3个先决条件：患者自身因素、疾病有关因素、医疗保健资源因素;3个结局指标：药物不良反应、临床不良结局、患者服药依从性下降。结论多重用药概念尚未统一,国内相关研究尚处于起步阶段,厘清该概念有助于医疗护理人员加强患者药物管理指导,对保障患者用药安全产生重要影响。

关键词: 多重用药, 药物联合治疗, 潜在不恰当用药, 用药决策, Rodgers演化概念分析法

Abstract: Objective To define polypharmacy by Rodgers’ evolutionary concept analysis, and to provide theoretical basis for identifying rational drug use and avoiding potential medication errors. Methods The database of CNKI, WanFang Data, VIP, PubMed, Web of Science and CINAHL were systematically searched. The retrieval period was from the inception to February 2023. According to the inclusion criteria, 54 pieces of literature were selected to analyze and define polypharmacy under the guidance of Rodgers’ evolutionary concept analysis. Results Three conceptual attributes were involved in polypharmacy: drug combination, potential inappropriate drug use, and complexity of drug decision making; three prerequisites of individual factors of the patients, disease-related factors, and health care resource factors; three outcome indicators of adverse drug reactions, adverse clinical outcomes, and decreased patient compliance. Conclusion The concept of polypharmacy has not been unified, and relevant domestic studies are still in the infancy stage. Clarifying the concept will help medical staff strengthen drug management for patients, and will have an important impact on the safety of drug use for patients.

Key words: polypharmacy, drug combination therapy, potentially inappropriate drug use, medication decision, Rodgers’ evolutionary concept analysis

中图分类号:

R197.323.2

陈冉, 李春玉, 李美茜. 应用Rodgers演化概念分析法界定多重用药[J]. 护理学报, 2023, 30(17): 39-44.

CHEN Ran, LI Chun-yu, LI Mei-qian. Defining polypharmacy based on Rodgers’ evolutionary concept analysis[J]. Journal of Nursing, 2023, 30(17): 39-44.

参考文献

[1] 王丽敏, 陈志华, 张梅,等. 中国老年人群慢性病患病状况和疾病负担研究[J]. 中华流行病学杂志,2019,40(3):277-283. DOI:10.3760/cma.j.issn.0254-6450.2019.03.005.
[2] World Health Organization. Medication safety in polypharmacy[EB/OL].(2019-06-20)[2023-02-02].https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.11.
[3] Guillot J, Maumus-Robert S, Bezin J.Polypharmacy: a general review of definitions, descriptions and determinants[J]. Therapie, 2020, 75(5):407-416. DOI:10.1016/j.therap.2019.10.001.
[4] 李晴歌, 胡嘉乐, 郑窑文,等. 概念分析方法及在护理研究中的应用[J]. 护理学杂志,2018,33(4):100-102. DOI:10.3870/j.issn.1001-4152.2018.04.100.
[5] 李依霖, 康晓凤, 邢海英,等. PubMed数据库中护理相关概念分析的计量学研究[J].护理学报,2016,23(23):6-10. DOI:10.16460/j.issn1008-9969.2016.23.006.
[6] Rodgers BL.Concepts, analysis and the development of nursing knowledge: the evolutionary cycle[J]. J Adv Nurs,1989,14(4):330-335. DOI:10.1111/j.1365-2648.1989.tb03420.x.
[7] Payne RA.The epidemiology of polypharmacy[J]. Clin Med (Lond),2016,16(5):465-469. DOI:10.7861/clinmedicine.16-5-465.
[8] Stewart RB.Polypharmacy in the elderly: a fait accompli?[J]. DICP,1990,24(3):321-323.DOI:10.1177/106002809002400320.
[9] Bikowski RM, Ripsin CM, Lorraine VL.Physician-patient congruence regarding medication regimens[J]. J Am Geriatr Soc,2001,49(10):1353-1357.DOI:10.1046/j.1532-5415.2001.49265.x.
[10] WHO Centre for Health Development. A glossary of terms for community health care and services for older persons[EB/OL].(2004-02-02)[2023-02-02].https://www.who.int/iris/handle/10665/68896.
[11] Dreischulte T, Shahid F, Muth C, et al.Prescribing cascades: how to detect them, prevent them, and use them appropriately[J]. Dtsch Arztebl Int,2022,119(44):745-752. DOI:10.3238/arztebl.m2022.0306.
[12] 中国老年保健医学研究会老年内分泌与代谢病分会, 中国毒理学会临床毒理专业委员会. 老年人多重用药安全管理专家共识[J]. 中国全科医学,2018,21(29):3533-3544. DOI:10.12114/j.issn.1007-9572.2018.00.225.
[13] Fincke BG, Snyder K, Cantillon C, et al.Three complementary definitions of polypharmacy: methods, application and comparison of findings in a large prescription database[J]. Pharmacoepidemiol Drug Saf, 2005, 14(2):121-128. DOI:10.1002/pds.966.
[14] Nobili A, Franchi C, Pasina L, et al.Drug utilization and polypharmacy in an Italian elderly population: the EPIFARM-elderly project[J]. Pharmacoepidemiol Drug Saf,2011,20(5):488-496. DOI:10.1002/pds.2108.
[15] Bjerrum L, Søgaard J, Hallas J, et al.Polypharmacy: correlations with sex, age and drug regimen.A prescription database study[J]. Eur J Clin Pharmacol,1998,54(3):197-202. DOI:10.1007/s002280050445.
[16] Masnoon N, Shakib S, Kalisch-Ellett L, et al.What is polypharmacy? A systematic review of definitions[J]. BMC Geriatrics,2017,17(1):230.DOI:10.1186/s12877-017-0621-2.
[17] By the 2019 American Geriatrics Society Beers Criteria^® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria? for potentially inappropriate medication use in older adults the 2019 American Geriatrics Society Beers Criteria^® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria? for potentially inappropriate medication use in older adults[J]. J Am Geriatr Soc,2019,67(4):674-694. DOI:10.1111/jgs.15767.
[18] O’Mahony D, O’Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2[J]. Age Ageing, 2015,44(2):213-218. DOI:10.1093/ageing/afu145.
[19] Kadam UT, Roberts I, White S, et al.Conceptualizing multiple drug use in patients with comorbidity and multimorbidity: proposal for standard definitions beyond the term polypharmacy[J]. J Clin Epidemiol,2019,106:98-107. DOI:10.1016/j.jclinepi.2018.10.014.
[20] 乔高星, 楚尧娟, 刘冲,等. 2012-2021年潜在不适当用药的研究热点与趋势分析[J]. 中国药房,2023,34(3):370-375. DOI:10.6039/j.issn.1001-0408.2023.03.22.
[21] 迟俊婷, 牛晓丹, 阮海慧,等. 老年人潜在不适当用药的评估工具及应用进展[J]. 护理学报,2019, 26(23):36-40. DOI:10.16460/j.issn1008-9969.2019.23.036.
[22] Gillette C, Prunty L, Wolcott J, et al.A new lexicon for polypharmacy: implications for research, practice, and education[J]. Res Social Adm Pharm, 2015,11(3):468-471. DOI:10.1016/j.sapharm.2014.08.010.
[23] Bitter K, Pehe C, Krüger M, et al.Pharmacist-led medication reviews for geriatric residents in German long-term care facilities[J]. BMC Geriatr,2019, 19(1):39. DOI:10.1186/s12877-019-1052-z.
[24] 付洋洋, 陈苏红, 孟美美,等. 医院用药安全多学科协作护理团队运作模式研究进展[J]. 护士进修杂志,2018,33(4):319-322. DOI:10.16821/j.cnki.hsjx.2018.04.008.
[25] Krause O, Wiese B, Doyle I M, et al.Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study)[J]. BMC Geriatr,2019, 19(1):24. DOI:10.1186/s12877-019-1027-0.
[26] 刘畅, 周彬, 徐笑,等. 全国感染防控改进目标信息管理系统的设计与应用[J]. 中国数字医学,2023,18(4):1-7. DOI:10.3969/j.issn.1673-7571.2023.04.001.
[27] Woodford H J.Calcium channel blockers co-prescribed with loop diuretics: a potential marker of poor prescribing?[J]. Drugs Aging, 2020,37(2):77-81. DOI:10.1007/s40266-019-00730-4.
[28] 王春霞, 贺梦璐, 王海鹏,等. 山东省农村地区多重慢病患者多重用药现状及影响因素分析[J]. 山东大学学报(医学版),2022,60(1):93-100. DOI:10.6040/j.issn.1671-7554.0.2021.0913.
[29] Gharekhani A, Somi M, Ostadrahimi A, et al.Prevalence and predicting risk factors of polypharmacy in Azar cohort population[J]. Iran J Pharm Res.2022,21(1):e126922. DOI:10.5812/ijpr-126922.
[30] 李荔, 李莎, 卫芸,等. 社区老年人多重用药率及其相关因素的系统综述[J]. 中国全科医学,2021,24(25):3161-3170. DOI:10.12114/j.issn.1007-9572.2021.00.204.
[31] 王永利, 栾文艳, 郭亚雯,等. 居家老年多病共存患者多重用药体验的质性研究[J]. 中国全科医学, 2020,23(17):2197-2202. DOI:10.3969/j.issn.1008-9993.2014.22.001.
[32] Arabyat RM, Alazzam OM, Al-Azzam SI, et al.Association between charlson comorbidity index and polypharmacy: a retrospective database study from Jordan[J]. Int J Pharm Pract.2021,29(6):580-586. DOI:10.1093/ijpp/riab067.
[33] Diaconu CC, Cozma MA, Dobric EC, et al.Polypharmacy in the management of arterial hypertension-friend or foe?[J]. Medicina(Kaunas), 2021,57(12):1288.DOI:10.3390/medicina57121288.
[34] Stafford G, Villen N, Roso-Llorach A, et al.Combined multimorbidity and polypharmacy patterns in the elderly: a cross-sectional study in primary health care[J]. Int J Environ Res Public Health, 2021, 18(17):9216. DOI:10.3390/ijerph18179216.
[35] Veehof L, Stewart R, Haaijer-Ruskamp F, et al.The development of polypharmacy.A longitudinal study[J].Fam Pract,2000,17(3):261-267. DOI:10.1093/fampra/17.3.261.
[36] Pereira KG, Peres MA, Iop D, et al.Polypharmacy among the elderly: a population-based study[J]. Rev Bras Epidemiol,2017, 20(2):335-344.DOI:10.1590/1980-5497201700020013.
[37] 吴汀溪, 邢云利, 黄凤,等. 老年多重用药住院患者的用药现状评估及药师干预效果评价[J].中国药房,2019,30(22):3150-3154. DOI:10.6039/j.issn.1001-0408.2019.22.25.
[38] 费春晓. 老年共病患者多重用药与肾损伤的相关性研究[D]:青岛:青岛大学,2020.DOI:10.27262/d.cnki.gqdau.2020.001145.
[39] 李凤,王建华, 宋开兰. 老年病人多重用药的研究进展[J]. 护理研究,2020, 34(23):4207-4210. DOI:10.12102/j.issn.1009-6493.2020.23.019.
[40] Veronese N, Stubbs B, Noale M, et al.Polypharmacy is associated with higher frailty risk in older people: an 8-year longitudinal cohort study[J]. J Am Med Dir Assoc,2017,18(7):624-628. DOI:10.1016/j.jamda.2017.02.009.
[41] Dhalwani NN, Fahami R, Sathanapally H, et al.Association between polypharmacy and falls in older adults: a longitudinal study from England[J].BMJ Open,2017,7(10):e016358. DOI:10.1136/bmjopen-2017-016358.
[42] Sganga F, Landi F, Ruggiero C, et al.Polypharmacy and health outcomes among older adults discharged from hospital: results from the CRIME study[J]. Geriatr Gerontol Int,2015,15(2):141-146. DOI:10.1111/ggi.12241.
[43] Brockhattingen KK, Anru PL, Masud T, et al.Association between number of medications and mortality in geriatric inpatients: a Danish nationwide register-based cohort study[J]. Eur Geriatr Med,2020,11(6):1063-1071. DOI:10.1007/s41999-020-00390-3.
[44] Vicente S, Olmos-Jiménez R, Ramírez-Roig C, et al.Treatment adherence in patients older than 65 years who suffer early readmissions[J]. Farm Hosp, 2018,42(4):147-151. DOI:10.7399/fh.10907.
[45] 李晨. 老年住院患者多重用药干预体系构建[D].北京:中国人民解放军医学院,2019.DOI:10.27637/d.cnki.gjyjc.2019.000135.
[46] 廖雅慧, 郎驿天, 林燕,等. 常用老年人潜在不适当用药判断标准比较[J]. 中国药房,2022,33(9):1131-1135. DOI:10.6039/j.issn.1001-0408.2022.09.18.
[47] 刘夏, 潘琴, 徐迅科,等. 基于《中国老年人潜在不适当用药判断标准(2017版)》的老年患者不适当用药评价研究[J]. 药学实践杂志,2019,37(3):283-288. DOI:10.3969/j.issn.1006-0111.2019.03.019.
[48] 黄静, 蔡娟娟, 吴伦. 老年内分泌疾病患者的潜在不适当用药及影响因素分析[J]. 中国医院药学杂志,2023,43(4):431-435. DOI:10.13286/j.1001-5213.2023.04.15.
[49] 何梅, 邵鑫, 赵曜,等. Beers标准、STOPP/START标准及中国PIM初级判断标准评价某院心血管内科医嘱的对比研究[J]. 中国医院药学杂志,2018,38(7):781-784+791. DOI:10.13286/j.cnki.chinhosppharmacyj.2018.07.21.
[50] 尹茜, 曹立. 1例老年人急性期照护单元老年患者多重用药分析[J]. 医药导报,2022,41(3):406-409. DOI:10.3870/j.issn.1004-0781.2022.03.024.

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