Roughead Elizabeth E, Semple Susan J, Gilbert Andrew L
School of Pharmaceutical Molecular and Biomedical Sciences, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia.
Drugs Aging. 2003;20(9):643-53. doi: 10.2165/00002512-200320090-00002.
Medication-related problems are most commonly reported in elderly patients. It is for this reason that the development of services supporting appropriate medication management in the elderly is paramount; particularly for those living in residential care facilities. In 1991, Australia had very limited services supporting the quality use of medicines for residents of aged-care facilities. Over 11 years, from 1991-2002, the range of services has expanded considerably. Federally funded medication review services are now available, with over 80% of residents provided with the service. Medication advisory committees, in accordance with national practice guidelines, have been established in many facilities to address issues concerning medication management. Fifty percent of Australian's pharmacies are registered to provide services, with over 10% of the country's pharmacists accredited to provide the service. National practice guidelines for medication management in aged-care facilities have been incorporated into accreditation standards for aged-care facilities, further integrating activity into the wider health system. The environment was created for these activities through the formation of the Pharmaceutical Health and Rational Use of Medicines (PHARM) Committee, an expert advisory committee, and the Australian Pharmaceutical Advisory Council (APAC), a representative council. Both groups had responsibility for advising the Federal Minister of Health. They both identified medication misadventure in residential aged care as a priority issue and through their recommendations the Government devoted funds to the development of best practice guidelines and research activity. Clinical pharmacy services in nursing-home and hostel settings were found to reduce the use of benzodiazepines, laxatives, NSAIDs and antacids leading to cost savings to the health system. Dose-administration aids were found to reduce error rates during medication administration, and the alteration of medications for administration to residents was found to be common practice and potentially problematic. Research in the Australian setting demonstrating effectiveness, as measured by changes in medication use or health outcomes, as well as actual or potential cost savings has been a critical success factor. In addition, prioritisation by government advisory committees, inquiries and policy documents, have assisted in the development of services from ideas in 1991 to nationally funded realities in 2002.
与药物治疗相关的问题在老年患者中最为常见。正因如此，发展支持老年人合理用药管理的服务至关重要；尤其是对于那些居住在养老院的老人。1991年，澳大利亚支持老年护理机构居民合理用药的服务非常有限。从1991年到2002年的11年间，服务范围有了显著扩大。现在有联邦政府资助的药物审查服务，超过80%的居民能够享受到这项服务。许多机构都按照国家实践指南设立了药物咨询委员会，以解决与药物管理有关的问题。澳大利亚50%的药店注册提供此类服务，超过10%的药剂师获得了提供该服务的认证。老年护理机构药物管理的国家实践指南已被纳入老年护理机构的认证标准，进一步将相关活动融入更广泛的卫生系统。通过成立专家咨询委员会——药物健康与合理用药委员会（PHARM）以及代表委员会——澳大利亚药物咨询委员会（APAC），为这些活动创造了环境。这两个组织都负责向联邦卫生部长提供建议。它们都将老年护理机构中的用药失误确定为优先问题，并通过其建议促使政府投入资金制定最佳实践指南和开展研究活动。在养老院和宿舍环境中开展的临床药学服务被发现可以减少苯二氮䓬类药物、泻药、非甾体抗炎药和抗酸剂的使用，从而为卫生系统节省成本。剂量给药辅助工具被发现可以降低用药过程中的错误率，并且发现为居民调整用药是常见做法且可能存在问题。在澳大利亚进行的研究表明，以药物使用或健康结果的变化以及实际或潜在的成本节约来衡量，其有效性是一个关键的成功因素。此外，政府咨询委员会的优先排序、调查和政策文件，有助于将1991年的想法发展为2002年由国家资助的实际服务。
