摘要目的:调查上海市社区老年慢性病患者的潜在不适当用药（PIM）情况，并分析其潜在影响因素，为减少老年慢性病患者PIM的发生提供理论依据。方法:采用分层抽样法选择上海市6家社区卫生服务中心，纳入2018年7月1日至8月31日在这6家社区卫生服务中心门诊就诊的老年慢性病患者（年龄≥65岁）968例，依据2015版Beers标准判断老年患者PIM情况，分析PIM的影响因素。结果:968例老年患者中共有317例（32.7%）患者发生了412例次PIM。老年人与疾病状态无关的PIM共有134例次，由药物-疾病/症状相互作用导致的PIM共18例次，使用了需慎用药物的PIM为259例次，仅发现1例次因药物-药物相互作用导致的PIM。PIM发生比例最高的药物依次是利尿剂、苯二氮 类和阿司匹林。有PIM的老年患者与无PIM的老年患者相比，年龄、患病种数、联合用药数和就诊次数的差异有统计学意义（χ 2=42.28、35.51、46.47、38.46，均 P<0.05）。老年慢性病患者的年龄、患病种数、联合用药数和就诊次数是影响其发生PIM的主要因素。 结论:上海市社区老年慢性病患者PIM发生率较高，对于社区老年慢性病患者总体而言，年龄、患病种数、联合用药数和就诊次数是其发生PIM的影响因素。

abstractsObjective:To investigate the potentially inappropriate medication(PIM)among elderly patients with chronic diseases in Shanghai communities and related influence factors.Method:Six community Health service Centers were choosen using stratified sampling. Total 968 elderly patients with chronic diseases who visited to the outpatient clinic of Shanghai Community Health Service Centers from July to August 2018 were included in the study. The PIM was investigated according to the 2015 Beers criteria. The χ 2 test and multivariate logistic regression model were used to analyze factors related to the PIM. Results:The survey showed that 317 elderly patients had PIM with 412 person-doses. In 134 person-doses, the PIM was unrelated to the disease; in 18 person-doses, PIM was caused by interaction of drug with disease/symptoms; in 259 person-doses PIM was related to the drugs that should be cautiously used for elderly; only in 1 person-dose the PIM was caused by the interaction between drugs. The drugs with the highest proportion of PIM were diuretics, benzodiazepines and aspirin. There were significant differences in age, kinds of diseases, kinds of drugs and times of visiting community health service centers between elderly patients with PIM and those without PIM (χ 2=42.28, 35.51, 46.47, 38.46; all P<0.05). The main PIM-related factors were age, kinds of diseases, kinds of drugs and times of visiting community health service centers. Conclusion:The study shows that the prevalence of PIM among elderly chronic diseases patients in Shanghai communities is relatively high, which is associated with the age, kinds of diseases, kinds of drugs and times of visiting community health service centers.