优化老年多病患者处方的方法：在全科医生的病史记录中的应用结果。
Prescribing optimization method for improving prescribing in elderly patients receiving polypharmacy: results of application to case histories by general practitioners.
机构信息
Department of Geriatric Medicine, University Medical Centre, Utrecht, the Netherlands.
出版信息
Drugs Aging. 2009;26(8):687-701. doi: 10.2165/11316400-000000000-00000.
BACKGROUND
Optimizing polypharmacy is often difficult, and critical appraisal of medication use often leads to one or more changes. We developed the Prescribing Optimization Method (POM) to assist physicians, especially general practitioners (GPs), in their attempts to optimize polypharmacy in elderly patients. The POM is based on six questions: (i) is undertreatment present and addition of medication indicated; (ii) does the patient adhere to his/her medication schedule; (iii) which drug(s) can be withdrawn or which drugs(s) is/are inappropriate for the patient; (iv) which adverse effects are present; (v) which clinically relevant interactions are to be expected; and (vi) should the dose, dose frequency and/or form of the drug be adjusted?
OBJECTIVE
The aim of this study was to evaluate the usefulness of the POM as a tool for improving appropriate prescribing of complex polypharmacy in the elderly.
METHODS
Forty-five GPs were asked to optimize the medication of two case histories, randomly chosen from ten histories of geriatric patients admitted to a hospital geriatric outpatient clinic with a mean +/- SD of 7.9 +/- 1.2 problems treated with 8.7 +/- 3.1 drugs. The first case was optimized without knowledge of the POM. After a 2-hour lecture on the POM, the GPs used the POM to optimize the medication of the second case history. The GPs were allowed 20 minutes for case optimization. Medication recommendations were compared with those made by an expert panel of four geriatricians specialized in clinical pharmacology. Data were analysed using a linear mixed effects model.
RESULTS
Optimization was significantly better when GPs used the POM. The proportion of correct decisions increased from 34.7% without the POM to 48.1% with the POM (p = 0.0037), and the number of potentially harmful decisions decreased from a mean +/- SD of 3.3 +/- 1.8 without the POM to 2.4 +/- 1.4 with the POM (p = 0.0046).
CONCLUSION
The POM improves appropriate prescribing of complex polypharmacy in case histories.
背景
优化多种药物治疗常常很困难，对药物使用的严格评估通常会导致一项或多项改变。我们开发了处方优化方法（POM）以协助医生，特别是全科医生（GP），试图优化老年患者的多种药物治疗。POM 基于六个问题：（i）是否存在治疗不足并需要加用药物；（ii）患者是否遵循其用药时间表；（iii）哪些药物可以停用或不适合患者；（iv）是否存在不良反应；（v）预期会有哪些临床相关的相互作用；以及（vi）是否应调整药物剂量、剂量频率和/或剂型？
目的
本研究旨在评估 POM 作为一种工具在改善老年人复杂多种药物治疗中的适当性方面的有用性。
方法
随机选择十名住院老年门诊患者的病史中的两个，每位全科医生被要求优化这些病史中的药物治疗，每位 GP 都被要求在 20 分钟内优化病例。第一个病例是在不了解 POM 的情况下进行优化的。在接受了 2 小时关于 POM 的讲座后，GP 使用 POM 优化第二个病例的药物治疗。GP 被允许 20 分钟用于病例优化。比较 GP 的药物推荐与四位专门从事临床药理学的老年医学专家小组的建议。使用线性混合效应模型进行数据分析。
结果
使用 POM 时，优化效果明显更好。正确决策的比例从没有 POM 时的 34.7%增加到使用 POM 时的 48.1%（p = 0.0037），潜在有害决策的数量从没有 POM 时的平均 3.3 ± 1.8 减少到使用 POM 时的 2.4 ± 1.4（p = 0.0046）。
结论
POM 改善了病史中复杂多种药物治疗的适当性。
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