摘要
背景 质子泵抑制剂(PPI)长期服用的潜在风险和潜在不合理用药问题逐渐得到重视.PPI处方精简已得到广泛认同,我国社区居民中长期服用PPI的情况及进行PPI处方精简的意愿尚不明确.目的 了解社区居民长期服用PPI及PPI处方精简的现状,探讨其影响因素并提出改进措施.方法 于 2018 年 4 月—2020 年 1 月对在北京市西城区什刹海社区卫生服务中心就诊长期服用PPI的 389 例居民进行调查,通过社区电子健康信息系统和电话问卷调查收集居民一般情况、PPI使用情况、是否同时使用非甾体类抗炎药(NSAIDs)和/或抗血小板药物、合并慢性疾病情况、用药数量、是否可开展PPI精简处方、多重用药情况等.通过电话问卷调查 2020 年 6-12 月仍长期服用PPI的 92 例居民对PPI长期服用的认知和处方精简态度.对可开展处方精简居民连续服用PPI时间>6 个月的影响因素采用多因素Logistic回归分析.结果 本次调查排除拒绝回答或无法联系、未连续服用PPI的患者后,最终 318 例长期服用PPI的居民纳入研究,平均年龄(63.9±12.5)岁,女性占 61.0%,合并慢性疾病的数量平均为(3.3±1.4)种,用药数量平均为(6.1±3.3)种.可开展PPI处方精简的居民 231 例(72.6%).PPI的处方指征中预防NSAIDs和抗血小板药物消化道损伤最多[202 例(63.5%)].多因素Logistic回归分析显示:居民的年龄(OR=1.044,95%CI=1.016～1.073)、用药数量(OR=1.175,95%CI=1.009～1.376)是连续服用PPI>6 个月的影响因素(P<0.05).2020 年 6-12 月仍长期服用PPI且可开展处方精简的居民中 82.6%(76/92)知晓药物使用适应证,70.7%(65/92)不了解长期服用PPI的潜在不良反应,71.7%(66/92)的愿意在全科医生的帮助下精简PPI处方,对于处方精简的主要担心是症状反复.结论 社区卫生服务机构长期服用PPI居民的年龄较大、女性居多,多重用药比例高;应关注年龄大、用药数量较多居民使用PPI药物的情况,需加强对PPI长期服用潜在风险的宣教;长期服用PPI的居民对PPI处方精简的态度积极,但需加强对PPI长期用药管理.
Abstract
Background The potential risks of long-term use of proton pump inhibitor(PPI)and the potentially inappropriate medication are gradually being taken into account,and PPI deprescribing has been widely recognised,but the situation of long-term use of PPI and the willingness to deprescribing of PPI among the community residents in our country are not yet clear.Objective To understand the current situation of long-term PPI use and PPI deprescribing among community residents,explore its influencing factors and propose improvement measures.Methods From April 2018 to January 2020,a survey was conducted among 389 residents of the Shichahai Community Health Service Center in Xicheng District,Beijing,who had been taking proton pump inhibitors(PPIs)chronically.Data on participants'demographics,PPI usage patterns,concurrent use of nonsteroidal anti-inflammatory drugs(NSAIDs)and/or antiplatelet agents,presence of comorbid chronic diseases,medication quantities,potential for PPI deprescribing,and polypharmacy status were collected via the community electronic health information system and telephone-administered questionnaires.Subsequently,between June and December 2020,telephone interviews were conducted with 92 residents still using PPIs long-term to assess their perceptions regarding prolonged PPI use and attitudes toward deprescribing.Multivariate Logistic regression analysis was employed to identify factors influencing the continuous PPI use exceeding six months among those deemed eligible for deprescribing.Results After excluding individuals who declined to participate,could not be reached,or had not taken PPIs continuously,the final study population consisted of 318 residents who were chronically using PPIs.The mean age of long-term PPI residents was(63.9±12.5)years,61.0%were female,the mean number of types of comorbid chronic diseases was(3.3±1.4),and the mean number of medications was(6.1±3.3),and the majority of the residents were able to carry out PPI deprescribing(231,72.6%).The prescribing indications for PPIs to prevent nonsteroidal anti-inflammatory drugs(NSAIDs)and antiplatelet drugs for gastrointestinal damage were the most frequent(202,63.5%).Multifactorial Logistic regression analysis showed that residents'age and number of medications were influential factors for taking PPIs continuously for>6 months[OR=1.044,95%CI(1.016-1.073);OR=1.175,95%CI(1.009-1.376),P<0.05].Residents who were still taking PPIs chronically between June and December 2020 and were available to carry out deprescribing was available for a total of 92 residents,82.6%of respondents were aware of the indications for medication use,70.7%(65/92)of respondents were unaware of the potential risks of long-term PPI use,71.7%(66/92)were willing to deprescribe PPI with the help of their GP,and the main concern about deprescribing was recurring symptoms.Conclusion Long-term PPI residents in community health services are older and predominantly female,with a high proportion of multiple medication use;attention should be paid to the use of PPI medication by residents who are older and use a larger number of medications,and there is a need to strengthen the education on the potential risks of long-term use of PPIs,and long-term PPI users have a positive attitude towards PPI deprescribing,and there is a need to strengthen the management of long-term use of PPIs.
维普
万方数据