Flood Kellie L, Carroll Maria B, Le Cyndi V, Brown Cynthia J
Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35294-2041, USA.
Am J Geriatr Pharmacother. 2009 Jun;7(3):151-8. doi: 10.1016/j.amjopharm.2009.05.002.
A novel Oncology-Acute Care for Elders (OACE) unit that uses an interdisciplinary team to enhance recognition and management of geriatric syndromes in hospitalized older adult cancer patients has been established at Barnes-Jewish Hospital (St. Louis, Missouri). The OACE team includes a clinical pharmacist whose primary role is to improve the appropriateness of prescribing.
Using polypharmacy as the prototypical geriatric syndrome addressed by the OACE team, the objective of this study was to document the processes of communication of an interdisciplinary team and the impact on polypharmacy when the treating physician did not participate in the daily interdisciplinary team rounds.
This was a prospective, observational study of older cancer patients admitted to the OACE unit. We tracked processes and outcomes of interdisciplinary communication regarding medications by prospectively recording OACE team recommendations and evaluating the frequency of implementation of these recommendations through a chart review. Treating physicians, who did not attend team rounds, received these recommendations on a communication form placed in the patient's chart.
Forty-seven patients were included in the study. The mean (SD) age was 73.5 (7.5) years. Twenty-one percent (10/47) of patients were prescribed > or =1 Beers medication as part of their home-care regimen before admission to the OACE unit. The OACE team made 51 medication recommendations, and 42 of those recommendations (82%) were implemented. Twenty-five patients (53%) had an alteration in their medication regimen; 13 (28%) had a potentially inappropriate medication discontinued. A medication error was corrected in ~1 of every 8 patients (6/47 [13%]).
We found that polypharmacy was common in older cancer patients and increased during hospitali-zation. We also found that most OACE team recommendations communicated to physicians were implemented even though the primary physicians were not members of the OACE team. Future randomized trials are needed to assess the impact of the OACE team model of care on adverse events, survival, and cost in hospitalized older adult cancer patients.
巴恩斯-犹太医院（密苏里州圣路易斯）设立了一个新型的老年肿瘤急症护理（OACE）单元，该单元利用跨学科团队来加强对住院老年癌症患者老年综合征的识别和管理。OACE团队包括一名临床药师，其主要职责是提高处方的合理性。
以多重用药作为OACE团队所处理的典型老年综合征，本研究的目的是记录跨学科团队的沟通流程，以及当主治医生不参与每日跨学科团队查房时对多重用药的影响。
这是一项对入住OACE单元的老年癌症患者进行的前瞻性观察研究。我们通过前瞻性记录OACE团队的建议，并通过病历审查评估这些建议的实施频率，来跟踪关于药物治疗的跨学科沟通的过程和结果。未参加团队查房的主治医生通过放在患者病历中的沟通表格收到这些建议。
47名患者纳入研究。平均（标准差）年龄为73.5（7.5）岁。21%（10/47）的患者在入住OACE单元之前，其家庭护理方案中开具了≥1种被列入“Beers标准”的药物。OACE团队提出了51条用药建议，其中42条（82%）得到实施。25名患者（53%）的用药方案发生了改变；13名（28%）患者停用了潜在不适当的药物。约每8名患者中有1名（6/47 [13%]）的用药错误得到纠正。
我们发现多重用药在老年癌症患者中很常见，且在住院期间有所增加。我们还发现，即使主治医生不是OACE团队成员，传达给医生的大多数OACE团队建议也得到了实施。未来需要进行随机试验，以评估OACE团队护理模式对住院老年癌症患者不良事件、生存率和成本的影响。
