De Smet Peter A G M, Denneboom Wilma, Kramers Cees, Grol Richard
Scientific Institute Dutch Pharmacists, The Hague, The Netherlands.
Drugs Aging. 2007;24(9):733-60. doi: 10.2165/00002512-200724090-00003.
Regular performance of medication reviews is prominent among methods that have been advocated to reduce the extent and seriousness of drug-related problems, such as adverse drug reactions, drug-disease interactions, drug-drug interactions, drug ineffectiveness and cost ineffectiveness. Several screening tools have been developed to guide practising healthcare professionals and researchers in reviewing the medication patterns of elderly patients; however, each of these tools has its own limitations. This review discusses a wide range of general prescription-, treatment- and patient-related issues that should be taken into account when reviewing medication patterns by implicit screening. These include generic and therapeutic substitution; potentially superfluous or inappropriate medications; potentially inappropriate dosages or duration of treatment; drug-disease and drug-drug interactions; under-treatment; making use of laboratory test results; patient adherence, experiences and habits; appropriate dosage forms and packaging. A broad selection of specific examples and references that can be used as a basis for explicit screening of medication patterns in outpatients is also offered.
在已被提倡用于减少药物相关问题（如药物不良反应、药物与疾病相互作用、药物与药物相互作用、药物无效和成本无效）的严重程度的方法中，定期进行药物评估尤为突出。已经开发了几种筛查工具，以指导执业医护人员和研究人员评估老年患者的用药模式；然而，这些工具中的每一种都有其自身的局限性。本综述讨论了在通过隐性筛查评估用药模式时应考虑的广泛的一般处方、治疗和患者相关问题。这些问题包括通用名和治疗性替代；潜在多余或不适当的药物；潜在不适当的剂量或治疗持续时间；药物与疾病和药物与药物相互作用；治疗不足；利用实验室检查结果；患者依从性、经历和习惯；适当的剂型和包装。还提供了广泛的具体示例和参考文献，可作为门诊患者用药模式明确筛查的基础。
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