养老院内药物管理审查对药物负担指数的影响：回顾性分析。
Impact of residential medication management reviews on drug burden index in aged-care homes: a retrospective analysis.
机构信息
Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
出版信息
Drugs Aging. 2009;26(8):677-86. doi: 10.2165/11316440-000000000-00000.
BACKGROUND
The Drug Burden Index (DBI) is an evidence-based tool that associates medication exposure with functional outcomes in older people. Accredited clinical pharmacists performing medication reviews could consider including the DBI in their medication reviews to optimize prescribing in older people.
OBJECTIVE
To examine the impact of residential medication management reviews (RMMRs) performed by accredited clinical pharmacists on DBI in older people living in aged-care homes.
METHODS
A retrospective analysis was performed of a random sample of 500 de-identified RMMR reports from residents aged (mean +/- SD) 84 +/- 9.0 years who had medication reviews conducted by ten accredited clinical pharmacists from 1 January 2008 through 30 June 2008. The data on medication use were collected over 8 months across 62 aged-care homes. DBI scores were calculated at baseline, after the recommendations had been made by the pharmacist and after uptake of pharmacist recommendations by the general practitioner (GP).
RESULTS
A statistically significant decrease (p < 0.001) in median DBI score was observed as a result of uptake of pharmacist recommendations by the GP. GPs were more likely to take up recommendations made by pharmacists that resulted in a decrease in DBI score than recommendations that resulted in an increase in DBI score (60.7% vs 34.6%, respectively). The mean decrease in DBI as a result of pharmacist recommendations was 0.12 (95% CI 0.09, 0.14) representing a 20% decrease in mean baseline DBI for residents. When GPs implemented pharmacists' recommendations, DBI decreased by a mean of 12% from baseline (mean decrease 0.07; 95% CI 0.05, 0.08). Most of the recommendations proposed by the pharmacists involved withdrawing benzodiazepines or reducing antipsychotic drug dosage.
CONCLUSIONS
This is the first study in which DBI has been used as a tool to evaluate the impact of RMMRs conducted by accredited clinical pharmacists. The study demonstrates that pharmacist-conducted medication reviews can reduce prescribing of sedative and anticholinergic drugs in older people, resulting in a significant decrease in the DBI score.
背景
药物负担指数（DBI）是一种基于证据的工具，它将药物暴露与老年人的功能结果联系起来。执行药物审查的认证临床药剂师可以考虑在药物审查中纳入 DBI，以优化老年人的处方。
目的
研究由认证临床药剂师进行的住院药物管理审查（RMMR）对居住在养老院的老年人 DBI 的影响。
方法
对 2008 年 1 月 1 日至 2008 年 6 月 30 日期间，由 10 名认证临床药剂师对 500 名平均年龄（均值+/-标准差）为 84+/-9.0 岁的居住在养老院的居民进行随机抽样的 500 份匿名 RMMR 报告进行了回顾性分析。药物使用数据在 62 家养老院收集了 8 个月。在药剂师提出建议后和全科医生（GP）采纳药剂师建议后计算 DBI 分数。
结果
由于 GP 采纳了药剂师的建议，DBI 评分的中位数明显下降（p<0.001）。GP 更有可能采纳降低 DBI 评分的建议，而不是增加 DBI 评分的建议（分别为 60.7%和 34.6%）。由于药剂师的建议，DBI 平均下降 0.12（95%CI 0.09，0.14），这意味着居民的平均基线 DBI 下降了 20%。当 GP 实施药剂师的建议时，DBI 从基线平均下降 12%（平均下降 0.07；95%CI 0.05，0.08）。药剂师提出的建议大多涉及停用苯二氮䓬类药物或减少抗精神病药物剂量。
结论
这是第一项使用 DBI 作为工具评估认证临床药剂师进行的 RMMR 影响的研究。该研究表明，药剂师进行的药物审查可以减少老年人镇静和抗胆碱能药物的处方，从而显著降低 DBI 评分。
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