关键词: 老年人, 多病共存, 多重用药, 不合理用药, 影响因素分析

Abstract: Background　Multiple chronic conditions（MCC） refers to patients having two or more chronic diseases with a high incidence among the elderly population clinically and especially the problem of multiple drug use.Multiple drug use has brought about potential irrational drug use，which is a risk factor affecting the prognosis of the disease.The evaluation，management and optimization of multiple drug use are very important parts of the clinical management of MCC.It may be a way to improve the clinical efficacy and reduce medical costs.Objective　To analyze retrospectively the basic situation of multiple drug use in elderly patients with MCC and its influencing factors in the community.Methods　Through the community health management system，the basic data of the elderly patients aged ≥65 years old and signed with the community from June 2016 to June 2018 were obtained.According to the International Classification of Diseases（ICD-10），the data was classified and statistically analyzed.The elderly patients with two or more chronic diseases were defined as patients with MCC.Among them，400 patients were selected according to the random number table and enrolled in the multiple drug use（≥5 kinds of drugs） survey.Using Beers and STOPP/START standards to assess the potentially inappropriate medication（PIM）.Results　The patients with MCC accounted for 81.01%（10 908/13 465） of the total elderly patients over 65 years old.The main combinations of multiple chronic diseases were hypertension + coronary heart disease（22.0%），hypertension + diabetes（15.8%），and coronary heart disease+diabetes（16.2%）.Of the 400 questionnaires distributed，360 were effectively recovered，including 271 patients had multiple medications with the multiple medication rate of 75.3% and an average number of taking 5.7 kinds of drugs，up to 10 kinds.The drugs taken were mainly based on cardiovascular and endocrine therapy.Using STOPP/START standard，80（22.2%） patients were detected with 95 items of PIM，and a total of 21 potential ointments were detected in 18 patients（5.0%），and 57（15.8%）items of PIM were detected by Beers standard.Multivariate Logistic analysis showed that age and the main methods of prescriptions were the influencing factors of PIM（P<0.05）.Conclusion　The prevalence of MCC in the elderly over 65 years old is high.The proportion of multiple drug use in community elderly patients with MCC is high，and there is a problem of irrational drug use.Advanced age，unscheduled drug follow-up and evaluation，and single treatment mode may be the cause of irrational use for multiple drugs.As general practitioners who manage MCC chiefly，it is necessary for them to grasp the principle of assessing irrational drug use and improve the PIM of multiple drug use.

Key words: Aged, Multiple chronic conditions, Multiple drug use, Irrational drug use, Root cause analysis