Harder S, Saal K, Blauth E, Beyer M, Gerlach F M
Institute for Clinical Pharmacology, University Hospital Frankfurt am Main, Germany.
Int J Clin Pharmacol Ther. 2009 Feb;47(2):104-10. doi: 10.5414/cpp47104.
It is assumed that with increasing polypharmacy, medication surveillance by the General Practitioner (GP) and adherence to the therapy regimen by the patient will both decline.
We evaluated clinical and medication records taken from GP documentations in a cohort of 102 diabetic patients (48 f, 54 m, median age 70, range 39 - 81) with 3 or more chronic prescriptions. Patients were asked about their current medication and its tolerability by means of a structured telephone interview.
45% of the patients received up to 6 medications, 36% 7 - 9 and 19% > 10. The main comorbidity was hypertension (93%) and symptomatic CAD (39%). The use of established medications (beta-blockers and ACE inhibitors) for these comorbidities was appropriate. Although 76% were eligible for a statin therapy, only 51% actually took a statin, and 28% had a dose lower than the defined daily dose. 68% of the patients had no prescriptions other than those recorded in the GP documentation, but 8% of the total number of medicines taken by the patients were not recorded in the GP's database. 62% of patients took all the medication prescribed by the GP, while 7% of all medicines recorded in the GP's database were not taken by the patients. In 10% of cases, an incompatible medication (defined in accordance with a consented list) was taken by the patient. 81% of patients regularly (twice per year) had their HbA1c checked, but only 62% had their potassium levels checked, despite the use of ACI and diuretics. Most patients knew the reason for taking at least one medication, but 18% knew this for less than half of their (multiple) medications. 70% of the patients said they had been informed about the possible risks of their medication by the GP, and 7% knew the risks for only one medication.
In this cohort of patients on polypharmacy and with a high risk profile for adverse drug reactions, we found a mismatch between GPs' documentation of prescriptions and the medication taken by the patient. Patients had no detailed knowledge about indications and almost no knowledge about risks. Although the overall performance of therapy (appropriateness) was deemed sufficient, there would appear to be room for improvement in order to fill information gaps and strive for stricter surveillance.
假定随着联合用药的增加，全科医生（GP）的用药监测以及患者对治疗方案的依从性都会下降。
我们评估了从102例患有3种或更多慢性处方的糖尿病患者（48名女性，54名男性，年龄中位数70岁，范围39 - 81岁）的全科医生记录中获取的临床和用药记录。通过结构化电话访谈询问患者其当前用药情况及其耐受性。
45%的患者服用多达6种药物，36%服用7 - 9种，19%服用超过10种。主要合并症为高血压（93%）和有症状的冠心病（39%）。针对这些合并症使用的既定药物（β受体阻滞剂和ACE抑制剂）是恰当的。尽管76%的患者符合他汀类药物治疗条件，但实际只有51%服用了他汀类药物，且28%的患者服用剂量低于规定日剂量。68%的患者除了全科医生记录中的处方外没有其他处方，但患者所服用药物总数的8%未记录在全科医生的数据库中。62%的患者服用了全科医生开的所有药物，而全科医生数据库中记录的所有药物中有7%患者未服用。在10%的病例中，患者服用了不相容药物（根据一份商定清单定义）。81%的患者定期（每年两次）检查糖化血红蛋白（HbA1c），但尽管使用了ACE抑制剂和利尿剂，只有62%的患者检查了血钾水平。大多数患者知道至少一种药物的服用原因，但18%的患者对其（多种）药物中不到一半的药物了解服用原因。70%的患者表示他们已从全科医生处得知其用药可能存在的风险，7%的患者仅知道一种药物的风险。
在这组联合用药且药物不良反应风险较高的患者中，我们发现全科医生的处方记录与患者所服用药物之间存在差异。患者对用药指征没有详细了解，对风险几乎一无所知。尽管治疗的总体表现（恰当性）被认为是足够的，但为了填补信息空白并加强监测，似乎仍有改进空间。
