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目的 研制我国老年人疾病状态下潜在不适当用药(PIM)初级判断标准,为老年人临床合理用药提供依据和指导. 方法 收集美国、加拿大、泰国、韩国和我国台湾地区5个老年人疾病状态下PIM判断标准,经汇总、删重和整合后,设计出第1轮调查表,采用德尔菲法征询专家意见;对专家反馈的意见和建议进行整理后形成第2轮调查表再次征询专家意见.对专家权威程度、积极系数、协调系数,以及赋值指标均数和满分率进行计算.将筛选出的药物根据用药频率分别纳入A级(用药频率≥3000)、B级(用药频率＜3000)判断标准. 结果 参与2轮德尔菲法调查的专家分别为39、38人,选自我国11个省和3个直辖市的23家三级甲等医院,涉及神经病学、精神病学、心血管病学、消化病学、内分泌病学、泌尿生殖病学、老年医学、全科医学、疼痛医学、皮肤病学、呼吸病学等11个临床医学专业,以及临床药学、临床药理、医院药学等3个药学专业.2轮调查专家权威系数均在0.7以上,积极系数均为100％,协调系数分别为0.17和0.21,指标赋值均数分别为3.65和3.94,满分率均数分别为0.15和0.32.第1轮调查表含有89种(类)药物在31种疾病状态下存在的188个用药风险点;第2轮调查表含有44种(类)药物在27种疾病状态下存在的74个用药风险点.第2轮调查表所列指标均纳入我国老年人疾病状态下PIM初级判断标准.A级判断标准纳入35种(类)药物在25种疾病状态下的62个用药风险点,B级判断标准纳入9种(类)药物在9种疾病状态下的12个用药风险点. 结论 初步完成我国老年人疾病状态下PIM初级判断标准的研制,尚需通过临床应用不断完善,使之成为促进老年人合理用药、降低老年人用药风险的有力工具.,Objective To develop primary standard of potentially inappropriate medication (PIM) in Chinese aged people under morbid state and provide the basis and guide for clinical rational drug use in aged people.Methods Standards of PIM in aged people under morbid state of the United States,Canada,Thailand,South Korea,and the Taiwan area of China were collected and,after summarizing,removing duplication,and integrating,the first round questionnaire was designed according to Delphi method to ask for the experts’ opinions.The experts’ feedback and suggestions were organized and the second round questionnaire was designed to ask for opinions again.Authoritative coefficient,positive coefficient,coordinate coefficient,mean score,and full mark rate were calculated.The selected drugs were respectively divided into grade A (frequency ≥ 3 000) and B (frequency ＜ 3 000) standard according to medication frequency.Results Thirty nine and 38 experts respectively took part in the 2 rounds of Delphi method investigations,who were selected from 23 grade Ⅲa hospitals in 11 provinces and 3 municipalities directly under the central govment.These experts’ specialties involved 11 clinical medical specialties including neurology,psychiatry,cardiology,gastroenterology,endocrinology,urogenital epidemiology,gerontology,general medicine,pain medicine,dermatology,and respiratory medicine and 3 pharmacy specialties including clinical pharmacy,clinical pharmacology,and hospital pharmacy.After the 2 rounds of investigations,all of the authoritative coefficients of the experts were above 0.7,all of positive coefficients were 100％,and the first coordination coefficient were 0.17 and 0.21,respectively.Meanwhile,the mean scores were 3.65 and 3.94 and the means of full mark rates were 0.15 and 0.32,respectively.The first round investigation contained 188 points of drug-induced risks of 89 species (categories) of drugs under 31 kinds of morbid states and the second round investigation contained 74 points of drug-induced risks of 44 species (categories) of drugs under 27 kinds of morbid states.These indexes listed in the second round investigation were all enrolled the primary standard of PIM in Chinese aged people under morbid state.Grade A standard contained 62 points of drug-induced risks of 35 species (categories) of drugs under 25 kinds of morbid states,and grade B standard contained 12 points of drug-induced risks of 9 species (categories) of drugs under 9 kinds of morbid states.Conclusions The development of primary standard of PIM in Chinese aged people under morbid state has completed preliminarily.However,the standard still needs to be improved by clinical application to be used as a powerful tool for promoting rational drug use and lowering drug-induced risks of aged people.