Roberts M S, Stokes J A, King M A, Lynne T A, Purdie D M, Glasziou P P, Wilson D A, McCarthy S T, Brooks G E, de Looze F J, Del Mar C B
Department of Medicine, The University of Queensland, Brisbane, Australia.
Br J Clin Pharmacol. 2001 Mar;51(3):257-65. doi: 10.1046/j.1365-2125.2001.00347.x.
To evaluate whether a year long clinical pharmacy program involving development of professional relationships, nurse education on medication issues, and individualized medication reviews could change drug use, mortality and morbidity in nursing home residents.
A cluster randomised controlled trial, where an intervention home was matched to three control homes, was used to examine the effect of the clinical pharmacy intervention on resident outcomes. The study involved 905 residents in 13 intervention nursing homes and 2325 residents in 39 control nursing homes in south-east Queensland and north-east New South Wales, Australia. The outcome measures were: continuous drug use data from government prescription subsidy claims, cross-sectional drug use data on prescribed and administered medications, deaths and morbidity indices (hospitalization rates, adverse events and disability indices).
This intervention resulted in a reduction in drug use with no change in morbidity indices or survival. Differences in nursing home characteristics, as defined by cluster analysis with SUDAAN, negated intervention-related apparent significant improvements in survival. The use of benzodiazepines, nonsteroidal anti-inflammatory drugs, laxatives, histamine H2-receptor antagonists and antacids was significantly reduced in the intervention group, whereas the use of digoxin and diuretics remained similar to controls. Overall, drug use in the intervention group was reduced by 14.8% relative to the controls, equivalent to an annual prescription saving of A64 dollars per resident (approximately 25 pound sterling).
This intervention improved nursing home resident outcomes related to changes in drug use and drug-related expenditure. The continuing divergence in both drug use and survival at the end of the study suggests that the difference would have been more significant in a larger and longer study, and even more so using additional instruments specific for measuring outcomes related to changes in drug use.
评估一项为期一年的临床药学项目，该项目涉及建立专业关系、对护士进行用药问题教育以及开展个体化用药评估，是否能够改变养老院居民的药物使用情况、死亡率和发病率。
采用整群随机对照试验，将一所干预养老院与三所对照养老院进行匹配，以检验临床药学干预对居民结局的影响。该研究涉及澳大利亚昆士兰州东南部和新南威尔士州东北部13所干预养老院的905名居民以及39所对照养老院的2325名居民。结局指标包括：来自政府处方补贴申请的持续药物使用数据、关于处方和服用药物的横断面药物使用数据、死亡和发病率指标（住院率、不良事件和残疾指标）。
该干预导致药物使用减少，但发病率指标和生存率未发生变化。通过使用SUDAAN进行聚类分析所定义的养老院特征差异，抵消了干预相关的生存率方面明显的显著改善。干预组中苯二氮䓬类药物、非甾体抗炎药、泻药、组胺H2受体拮抗剂和抗酸剂的使用显著减少，而地高辛和利尿剂的使用与对照组相似。总体而言，干预组的药物使用相对于对照组减少了14.8%，相当于每位居民每年节省64澳元的处方费用（约合25英镑）。
该干预改善了与药物使用变化和药物相关支出有关的养老院居民结局。研究结束时药物使用和生存率的持续差异表明，在规模更大、时间更长的研究中，这种差异会更加显著，使用更多专门用于测量与药物使用变化相关结局的工具时更是如此。
