Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus Sygehus, Aarhus, Denmark.
Basic Clin Pharmacol Toxicol. 2010 May;106(5):422-7. doi: 10.1111/j.1742-7843.2009.00511.x. Epub 2010 Jan 3.
Elderly patients are vulnerable to medication errors and adverse drug events due to increased morbidity, polypharmacy and inappropriate interactions. The objective of this study was to investigate whether systematic medication review and counselling performed by a clinical pharmacist and clinical pharmacologist would reduce length of in-hospital stay in elderly patients admitted to an acute ward of internal medicine. A randomized, controlled study of 100 patients aged 70 years or older was conducted in an acute ward of internal medicine in Denmark. Intervention arm: a clinical pharmacist conducted systematic medication reviews after an experienced medical physician had prescribed the patients' medication. Information was collected from medical charts, interview with the patients and database registrations of drug purchase. Subsequently, medication histories were conferred with a clinical pharmacologist and advisory notes recommending medication changes were completed. Physicians were not obliged to comply with the recommendations. Control arm: medication was reviewed by usual routine in the ward. Primary end-point was length of in-hospital stay. In addition, readmissions, mortality, contact to primary healthcare and quality of life were measured at 3-month follow-up. In the intervention arm, the mean length of in-hospital stay was 239.9 hr (95% CI: 190.2-289.6) and in the control arm: 238.6 hr (95% CI: 137.6-339.6), which was neither a statistical significant nor a clinically relevant difference. Moreover, no differences were observed for any of the secondary end-points. Systematic medication review and medication counselling did not show any effect on in-hospital length of stay in elderly patients when admitted to an acute ward of internal medicine.
老年患者由于发病率增加、多种药物治疗和不当相互作用而易发生用药错误和药物不良事件。本研究旨在探讨由临床药师和临床药理学家进行系统的药物审查和咨询是否会缩短老年患者在内科急症病房的住院时间。在丹麦的内科急症病房进行了一项随机对照研究，纳入了 100 名 70 岁或以上的患者。干预组：在经验丰富的医生为患者开处方后，临床药师对患者的药物进行系统的药物审查。从病历、与患者的访谈和药物购买数据库登记中收集信息。随后，与临床药理学家核对药物史，并完成建议药物变更的咨询说明。医生没有义务遵守这些建议。对照组：病房按照常规进行药物审查。主要终点是住院时间。此外，在 3 个月的随访中还测量了再入院率、死亡率、与初级保健的联系和生活质量。在干预组，平均住院时间为 239.9 小时（95%CI：190.2-289.6），在对照组为 238.6 小时（95%CI：137.6-339.6），差异既无统计学意义，也无临床意义。此外，次要终点也没有观察到差异。当老年患者被收治到内科急症病房时，系统的药物审查和药物咨询并没有对住院时间产生任何影响。
