德美日FORTA系统用于老年患者多重用药分级管理的比较

张倩; 李少强; 张镭; 李朋梅

doi:10.6039/j.issn.1001-0408.2023.06.01

您当前的位置：

首页 >

文章列表页 >

德美日FORTA系统用于老年患者多重用药分级管理的比较

药事管理 | 更新时间：2023-03-24

- 德美日FORTA系统用于老年患者多重用药分级管理的比较
- Comparison of German， American and Japanese FORTA systems for hierarchical management of polypharmacy in elderly patients
- 中国药房 2023年34卷第6期页码：641-647
- 作者机构：
  
  中日友好医院药学部，北京　100029
- 作者简介：
  
  药师，硕士。研究方向：临床药学。电话：010-84205563。E-mail：13390910263@163.com
  副主任药师，硕士。研究方向：临床药学。电话：010-84205563。E-mail：lipengmei@yeah.net
- 基金信息：
  
  国家重点研发计划主动健康和老龄化科技应对重点专项(2020YFC2005504)
- DOI：10.6039/j.issn.1001-0408.2023.06.01
  中图分类号： R969.3
- 纸质出版日期：2023-03-30，
  
  收稿日期：2022-11-24，
  
  修回日期：2023-02-16，
扫描看全文
张倩,李少强,张镭等.德美日FORTA系统用于老年患者多重用药分级管理的比较 ^Δ[J].中国药房,2023,34(06):641-647.

ZHANG Qian,LI Shaoqiang,ZHANG Lei,et al.Comparison of German， American and Japanese FORTA systems for hierarchical management of polypharmacy in elderly patients[J].ZHONGGUO YAOFANG,2023,34(06):641-647.
张倩,李少强,张镭等.德美日FORTA系统用于老年患者多重用药分级管理的比较 ^Δ[J].中国药房,2023,34(06):641-647. DOI： 10.6039/j.issn.1001-0408.2023.06.01.

ZHANG Qian,LI Shaoqiang,ZHANG Lei,et al.Comparison of German， American and Japanese FORTA systems for hierarchical management of polypharmacy in elderly patients[J].ZHONGGUO YAOFANG,2023,34(06):641-647. DOI： 10.6039/j.issn.1001-0408.2023.06.01.

摘要

目的

为我国老年患者多重用药的分级管理提供借鉴与参考。

方法

介绍老年患者用药分级系统FORTA（fit for the aged）的制定与发展过程，以老年患者常见的心脑血管系统疾病、神经精神类疾病治疗药物为例，比较德美日3版FORTA清单中疾病类型、药物种类及药物分级情况。结果与

结论

FORTA系统是首个将正面和负面标签相结合的分类系统，通过两轮德尔菲法形成，涵盖多种疾病和药物条目。FORTA清单涉及的心脑血管系统疾病主要包括急性冠脉综合征、心肌梗死后的长期治疗、心力衰竭、房颤、高血压、中风等。对于急性冠脉综合征、心肌梗死后的长期治疗和中风，相关药物的分级多为A级，3版清单的差异较小；其他疾病治疗药物分级有所差异。FORTA清单涉及的神经精神类疾病包括痴呆、癫痫、帕金森病、失眠/睡眠障碍、抑郁和双相情感障碍等，相关药物的分级多为负面标签，以C级和D级居多，仅有治疗帕金森病的左旋多巴为A级；3版清单中抗癫痫药物和治疗双相情感障碍的药物（除锂剂）分级较为统一，其余药物分级有所差异。相较于美国和日本的FORTA系统，德国FORTA系统更新了药物种类和临床证据，优化了疾病和药物分类，在一些药物分级上可能更为严格。3版FORTA清单中分级统一的药物可能具有较广的应用范围，我国可结合以上内容与临床实际，制定老年患者用药分级管理系统，以优化老年患者的用药选择，改善其临床治疗结局。

Abstract

OBJECTIVE

To provide reference for the hierarchical management of polypharmacy in elderly patients in China.

METHODS

The formulation and development process of drug hierarchical management system FORTA （fit for the aged） for elderly patients was introduced. The treatment drugs for common cardiovascular system diseases and neuropsychiatric diseases in elderly patients were taken as examples， the disease types， drug types and drug hierarchy in Germany-FORTA， the U.S.-FORTA and Japan-FORTA were compared. RESULTS &

CONCLUSIONS

FORTA system was the first drug hierarchical system that combined positive and negative labels， formed through two rounds of Delphi method and covered a variety of diseases and drug items. The cardiovascular system diseases covered by the FORTA list mainly included acute coronary syndrome， chronic therapy following myocardial infarction， heart failure， atrial fibrillation， hypertension， stroke， etc. For acute coronary syndrome， chronic therapy following myocardial infarction and stroke， the related drugs were mostly class A， and the differences between those FORTA lists were minimal. The hierarchy of drugs used to treat other diseases was various. The neuropsychiatric diseases covered by the FORTA list included dementia， epilepsy， Parkinson’s disease， insomnia/sleep disorder， depression and bipolar disorder， etc.， and the drug’s hierarchy was mostly labelled with negative， mostly class C and class D， and only levodopa to treat Parkinson’s disease was class A. The hierarchy of antiepileptic drugs and drugs for the treatment of bipolar disorder （except lithium） was relatively uniform in three FORTA lists， while the hierarchy of other drugs was different. Compared with the FORTA system in the U.S. and Japan， the Germany-FORTA system updated the drug types and clinical evidence， optimized the hierarchy of diseases and drugs， and may be stricter in some drug hierarchies. The drugs with uniform hierarchy in those FORTA lists may have a wide application range， and our country can combine the above content with clinical practice to formulate a drug hierarchical management system for elderly patients to optimize the drug selection of elderly patients and improve their clinical outcomes.

关键词

FORTA系统老年患者多重用药分级管理德国美国日本

Keywords

elderly patientspolyphar-macyhierarchical managementGermanythe U.S.Japan

references

United Nations. World population ageing 2019 highlights[EB/OL]. （2019-12-30）[2022-11-16]. https：//www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf#https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf#.

国家统计局. 第七次全国人口普查公报：第五号[EB/OL]. （2021-05-11）[2022-11-16]. http：//www.stats.gov.cn/tjsj/tjgb/rkpcgb/qgrkpcgb/202106/t20210628_1818824.htmlhttp://www.stats.gov.cn/tjsj/tjgb/rkpcgb/qgrkpcgb/202106/t20210628_1818824.html.

PAZAN F，WEHLING M. Polypharmacy in older adults：a narrative review of definitions，epidemiology and consequences[J]. Eur Geriatr Med，2021，12（3）：443-452.

TANG J，WANG K，YANG K，et al. A combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy：a multicenter cross-sectional study[J]. BMC Geriatr，2023，23（1）：44.

SKOLNICK A H，ALEXANDER K P. Older adults in clinical research and drug development：closing the geri- atric gap[J]. Circ Cardiovasc Qual Outcomes，2015，8（6）：631-633.

CLEGG A，RELTON C，YOUNG J，et al. Improving recruitment of older people to clinical trials：use of the cohort multiple randomised controlled trial design[J]. Age Ageing，2015，44（4）：547-550.

WATTS G. Why the exclusion of older people from clinical research must stop[J]. BMJ，2012，344：e3445.

MOTTER F R，FRITZEN J S，HILMER S N，et al. Potentially inappropriate medication in the elderly：a systematic review of validated explicit criteria[J]. Eur J Clin Pharmacol，2018，74（6）：679-700.

李莹，钱玉英，李耘，等. 老年人多重用药及评价工具的研究进展[J]. 中华老年多器官疾病杂志，2021，20（3）：229-232.

RUDOLF H，THIEM U，AUST K，et al. Reduction of potentially inappropriate medication in the elderly[J]. Dtsch Arztebl Int，2021，118（51/52）：875-882.

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.

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.

BEERS M H. Explicit criteria for determining potentially inappropriate medication use by the elderly： an update[J]. Arch Intern Med，1997，157（14）：1531-1536.

O’MAHONY D. STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people：origin and progress[J]. Expert Rev Clin Pharmacol，2020，13（1）：15-22.

O’MAHONY D，O’SULLIVAN D，BYRNE S，et al. STOPP/START criteria for potentially inappropriate pre-scribing in older people：version 2[J]. Age Ageing，2015，44（2）：213-218.

GALLAGHER P，RYAN C，BYRNE S，et al. STOPP （screening tool of older person’s prescriptions）and START （screening tool to alert doctors to right treatment）： consensus validation[J]. Int J Clin Pharmacol Ther，2008，46（2）：72-83.

王赛，刘琛，张兰，等. 中国老年人潜在不适当用药判断标准：2017年版[J]. 药物不良反应杂志，2018，20（1）：2-8.

KUHN-THIEL A M，WEIß C，WEHLING M，et al. Consensus validation of the FORTA （fit for the aged）list：a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly[J]. Drugs Aging，2014，31（2）：131-140.

WEHLING M. Drug therapy in the elderly：too much or too little，what to do? A new assessment system：fit for the aged （FORTA）[J]. Dtsch Med Wochenschr，2008，133（44）：2289-2291.

PAZAN F，WEISS C，WEHLING M，et al. The FORTA （fit for the aged） list 2021：fourth version of a validated clinical aid for improved pharmacotherapy in older adults[J]. Drugs Aging，2022，39（3）：245-247.

Medizinische Fakultät Mannheim. FORTA：fit for the aged[EB/OL]. [2022-11-16]. https：//www.umm.uni-he-idelberg.de/experimentelle-pharmakologie/research/group-wehling/https://www.umm.uni-he-idelberg.de/experimentelle-pharmakologie/research/group-wehling/.

PAZAN F，GERCKE Y，WEISS C，et al. The Japan-FORTA （fit for the aged） list：consensus validation of a clinical tool to improve drug therapy in older adults[J]. Arch Gerontol Geriatr，2020，91：104217.

PAZAN F，GERCKE Y，WEISS C，et al. The U.S.-FORTA （fit for the aged） list：consensus validation of a clinical tool to improve drug therapy in older adults[J]. J Am Med Dir Assoc，2020，21（3）：439.e9-439.e13.

PAZAN F，WEISS C，WEHLING M，et al. The EURO-FORTA （fit for the aged） list：international consensus validation of a clinical tool for improved drug treatment in older people[J]. Drugs Aging，2018，35（1）：61-71.

PAZAN F，WEHLING M. The fit for the aged （FORTA）project and its clinical implications[J]. Expert Opin Drug Metab Toxicol，2020，16（4）：275-277.

肖坚，黄娅敏，刘可可，等. 美国老年医学会2019版潜在不适当用药的Beers标准解读[J]. 药物流行病学杂志，2019，28（5）：341-350.

ALSHAMMARI H，AL-SAEED E，AHMED Z，et al. Reviewing potentially inappropriate medication in hospita-lized patients over 65 using explicit criteria：a systematic literature review[J]. Drug Healthc Patient Saf，2021，13：183-210.

CURTIN D，GALLAGHER P F，O’MAHONY D. Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences[J]. Ther Adv Drug Saf，2019，10：2042098619829431.

AWAD A，HANNA O. Potentially inappropriate medication use among geriatric patients in primary care setting：a cross-sectional study using the Beers，STOPP，FORTA and MAI criteria[J]. PLoS One，2019，14（6）：e0218174.

MICHALEK C，WEHLING M，SCHLITZER J，et al. Effects of “fit for the aged” （FORTA） on pharmacotherapy and clinical endpoints：a pilot randomized controlled study[J]. Eur J Clin Pharmacol，2014，70（10）：1261-1267.

WEHLING M，BURKHARDT H，KUHN-THIEL A，et al. VALFORTA：a randomised trial to validate the FORTA （fit for the aged） classification[J]. Age Ageing，2016，45（2）：262-267.

WEHLING M，COLLINS R，GIL V M，et al. Appropriateness of oral anticoagulants for the long-term treatment of atrial fibrillation in older people：results of an evidence-based review and international consensus validation process （OAC-FORTA 2016）[J]. Drugs Aging，2017，34（7）：499-507.

OELKE M，BECHER K，CASTRO-DIAZ D，et al. Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons：results of a systematic literature review and international consensus validation process （LUTS-FORTA 2014）[J]. Age Ageing，2015，44（5）：745-755.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

日本拓展性临床试验制度对我国同情用药制度的启示

日本药品上市后风险管理计划研究及对我国的启示