养老院医生和工作人员减少养老院居民非甾体抗炎药使用的教育项目：一项随机对照试验。

Educational program for nursing home physicians and staff to reduce use of non-steroidal anti-inflammatory drugs among nursing home residents: a randomized controlled trial.

作者信息

Stein C M, Griffin M R, Taylor J A, Pichert J W, Brandt K D, Ray W A

机构信息

Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.

出版信息

Med Care. 2001 May;39(5):436-45. doi: 10.1097/00005650-200105000-00004.

DOI:10.1097/00005650-200105000-00004

PMID:11317092

Abstract

CONTENT

The risk for serious gastrointestinal complications due to nonsteroidal anti-inflammatory drugs (NSAIDs) is high in the elderly. Acetaminophen-based regimens are safer and may be as effective as NSAIDs for the treatment of osteoarthritis in many patients.

OBJECTIVE

To determine the effects of an educational program on NSAID use and clinical outcomes in nursing homes.

DESIGN AND SETTING

Randomized controlled study. Ten pairs of Tennessee nursing homes with > or = 8% of residents receiving NSAIDs were randomized to intervention or control.

SUBJECTS

Nursing home residents (intervention n = 76 and control n = 71) aged 65 years and older taking NSAIDs regularly.

INTERVENTIONS

An educational program for physicians and nursing home staff that included the risks and benefits of NSAIDs in the elderly and an algorithm that substituted acetaminophen, topical agents, and nonpharmacologic measures for the treatment of noninflammatory musculoskeletal pain. Intervention and control subjects were assessed at baseline and 3 months later.

MAIN OUTCOME MEASURES

Differences in NSAID and acetaminophen use, and pain, function, and disability scores in intervention and control nursing home subjects.

RESULTS

The intervention was effective resulting in markedly decreased NSAID use and increased acetaminophen use. Mean number of days of NSAID use in the 7 day periods before the baseline and 3 month assessments decreased from 7.0 to 1.9 days in intervention home subjects compared with a decrease from 7.0 to 6.2 days in control homes (P = 0.0001). Acetaminophen use in the 7 days immediately before the 3 month assessment increased by 3.1 days in intervention home subjects compared with 0.31 days in control homes (P = 0.0001). A similar proportion of subjects in control (32.5%) and intervention (35.4%) groups had worsening of their arthritis pain score (P = 0.81).

CONCLUSIONS

An educational intervention effectively reduced NSAID use in nursing homes without worsening of arthritis pain.

摘要

内容

老年人因非甾体抗炎药（NSAIDs）导致严重胃肠道并发症的风险很高。对许多患者而言，以对乙酰氨基酚为基础的治疗方案更安全，且在治疗骨关节炎方面可能与非甾体抗炎药一样有效。

目的

确定一项教育计划对疗养院中NSAIDs使用情况及临床结局的影响。

设计与地点

随机对照研究。将田纳西州10对有≥8%的居民使用NSAIDs的疗养院随机分为干预组和对照组。

研究对象

65岁及以上定期服用NSAIDs的疗养院居民（干预组n = 76，对照组n = 71）。

干预措施

为医生和疗养院工作人员开展一项教育计划，内容包括NSAIDs在老年人中的风险和益处，以及一种用对乙酰氨基酚、局部用药和非药物措施替代治疗非炎性肌肉骨骼疼痛的算法。在基线和3个月后对干预组和对照组对象进行评估。

主要结局指标

干预组和对照组疗养院对象在NSAIDs和对乙酰氨基酚使用情况、疼痛、功能及残疾评分方面的差异。

结果

干预有效，导致NSAIDs使用显著减少，对乙酰氨基酚使用增加。与对照组疗养院对象在基线和3个月评估前7天内NSAIDs平均使用天数从7.0天降至6.2天相比，干预组疗养院对象从7.0天降至1.9天（P = 0.0001）。在3个月评估前的7天内，干预组疗养院对象对乙酰氨基酚的使用增加了3.1天，而对照组增加了0.31天（P = 0.0001）。对照组（32.5%）和干预组（35.4%）中关节炎疼痛评分恶化的受试者比例相似（P = 0.81）。