臺灣潛在性不適當用藥評估工具的發展與應用

The Development and Application of Drug Review Tool: Potentially Inappropriate Medication-Taiwan Criteria

10.6224/JN.201908_66(4).03

張勤斌(Chirn-Bin CHANG)；詹鼎正(Ding-Cheng CHAN)

潛在性不適當用藥 ； 條列式準則 ； 老年人 ； 多重用藥 ； potentially inappropriate medications ； explicit criteria ； older adults ； polypharmacy

護理雜誌

66卷4期（2019 / 08 / 01）

14 - 19

繁體中文

老年人因器官老化或疾病影響，對於藥物的吸收、作用與代謝也隨之改變。且隨著年齡增加身體功能下降與慢性病盛行比例增加，老年人使用藥物的機會與比例也隨之增加。特定一些藥物稱為「潛在性不適當藥物」，它們對於老年人較容易產生不良反應，且治療效果不明確或有其他較安全的替代藥物。隨著老年醫學的發展，各國陸續發展「潛在性不適當藥物」準則給予臨床人員參考、進行研究等運用。本篇文章主要介紹臺灣版準則的發展與應用，期能讓護理師了解老年用藥的相關知識與臺灣本土研究結果。

The absorption, action, and metabolism characteristics of drugs change in older adults due to factors including the normal process of aging and the impacts of disease on organ functions. Changes in the profile and proportions of drug use among older adults increase with increases in the severity of functional decline and the prevalence of chronic diseases. Drugs that are classified as ＂potentially inappropriate medications＂ (PIMs) carry a higher risk of causing adverse reactions in older adults, provide uncertain therapeutic benefits, or may be substituted by alternative drugs that are generally safer to use. Researchers have developed criteria for PIMs in geriatric medicine that are applicable to clinical practice and research. This article introduces the development and application of the PIM-Taiwan criteria to help nurses better understand the current knowledge related to medication use among older adults and the results of related research in Taiwan.

1. American Geriatrics Society Beers Criteria Update Expert Panel(2015).dated Beers criteria for potentially inappropriate medication use in older adults.Journal of the American Geriatrics Society,63(11),2227-2246.
2. American Geriatrics Society Beers Criteria Update Expert Panel(2012).American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults.Journal of the American Geriatrics Society,60(4),616-631.
3. Beers, M. H.,Ouslander, J. G.,Rollingher, I.,Reuben, D. B.,Brooks, J.,Beck, J. C.(1991).Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA division of geriatric medicine.Archives of Internal Medicine,151(9),1825-1832.
4. Chang, C. B.,Chan, D. C.(2010).Comparison of published explicit criteria for potentially inappropriate medications in older adults.Drugs & Aging,27(12),947-957.
5. Chang, C. B.,Chen, J. H.,Wen, C. J.,Kuo, H. K.,Lu, I. S.,Chiu, L. S.,Chan, D. C.(2011).Potentially inappropriate medications in geriatric outpatients with polypharmacy: Application of six sets of published explicit criteria.British Journal of Clinical Pharmacology,72(3),482-489.
6. Chang, C. B.,Lai, H. Y.,Yang, S. Y.,Wu, R. S.,Liu, H. C.,Hsu, H. Y.,Chan, D. C.(2014).Patient- and clinic visit-related factors associated with potentially inappropriate medication use among older home healthcare service recipients.PLOS ONE,9(4),e94350.
7. Chang, C. B.,Yang, S. Y.,Lai, H. Y.,Wu, R. S.,Liu, H. C.,Hsu, H. Y.,Chan, D. C.(2015).Application of three different sets of explicit criteria for assessing inappropriate prescribing in older patients: A nationwide prevalence study of ambulatory care visits in Taiwan.BMJ Open,5(11),e008214.
8. Chang, C. B.,Yang, S. Y.,Lai, H. Y.,Wu, R. S.,Liu, H. C.,Hsu, H. Y.,Chan, D. C.(2012).Using published criteria to develop a list of potentially inappropriate medications for elderly patients in Taiwan.Pharmacoepidemiology & Drug Safety,21(12),1269-1279.
9. Fick, D. M.,Cooper, J. W.,Wade, W. E.,Waller, J. L.,Maclean, J. R.,Beers, M. H.(2003).Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts.Archives of Internal Medicine,163(22),2716-2724.
10. Gallagher, P.,Ryan, C.,Byrne, S.,Kennedy, J.,O’Mahony, D.(2008).STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation.International Journal of Clinical Pharmacology and Therapeutics,46(2),72-83.
11. Holt, S.,Schmiedl, S.,Thürmann, P. A.(2010).Potentially inappropriate medications in the elderly: The PRISCUS list.Deutsches Arzteblatt International,107(31-32),543-551.
12. Keeney, S.,Hasson, F.,McKenna, H. P.(2001).A critical review of the Delphi technique as a research methodology for nursing.International Journal of Nursing Studies,38(2),195-200.
13. Kojima, T.,Mizukami, K.,Tomita, N.,Arai, H.,Ohrui, T.,Eto, M.,Akishita, M.(2016).Screening tool for older Persons’ appropriate prescriptions for Japanese: Report of the Japan Geriatrics Society Working Group on "guidelines for medical treatment and its safety in the elderly".Geriatrics and Gerontology International,16(9),983-1001.
14. Kuhn-Thiel, A. M.,Weiß, C.,Wehling, M.(2014).Consensus validation of the FORTA (Fit fOR The Aged) list: A clinical tool for increasing the appropriateness of pharmacotherapy in the elderly.Drugs & Aging,31(2),131-140.
15. Laroche, M. L.,Charmes, J. P.,Merle, L.(2007).Potentially inappropriate medications in the elderly: A French consensus panel list.European Journal of Clinical Pharmacology,63(8),725-731.
16. McLeod, P. J.,Huang, A. R.,Tamblyn, R. M.,Gayton, D. C.(1997).Defining inappropriate practices in prescribing for elderly people: A national consensus panel.CMAJ: Canadian Medical Association Journal,156(3),385-391.
17. O’Mahony, D.,O'sullivan, D.,Byrne, S.,O’Connor, M. N.,Ryan, C.,Gallagher, P.(2015).STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2.Age and Ageing,44(2),213-218.
18. O'Mahony, D,Gallagher, P. F.(2008).Inappropriate prescribing in the older population: Need for new criteria.Age and Ageing,37(2),138-141.
19. Rancourt, C.,Moisan, J.,Baillargeon, L.,Verreault, R.,Laurin, D.,Grégoire, J.-P.(2004).Potentially inappropriate prescriptions for older patients in long-term care.BMC Geriatrics,4,9.
20. Rognstad, S.,Brekke, M.,Fetveit, A.,Spigset, O.,Wyller, T. B.,Straand, J.(2009).The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified Delphi study.Scandinavian Journal of Primary Health Care,27(3),153-159.
21. Winit-Watjana, W.,Sakulrat, P.,Kespichayawattana, J.(2008).Criteria for high-risk medication use in Thai older patients.Archives of Gerontology and Geriatrics,47(1),35-51.
22. 楊淑瑜, S. Y.,詹鼎正, D. C.,張勤斌, C. B.,賴秀昀, H. Y.,吳如琇, R. S.,許秀櫻, H. Y.,張婉珍, W. J.(2011)。臺灣老人潛在性不適當用藥評估工具的發展。長期照護雜誌，15(3)，223-236。