识别和预防老年住院患者的药物不良事件：一项减少药物不良反应的计划的随机试验。
Identifying and preventing adverse drug events in elderly hospitalised patients: a randomised trial of a program to reduce adverse drug effects.
机构信息
Pole Vieillissement, Readaptation et Accompagnement, Hopital Paul Brousse, (APHP), Villejuif, France.
出版信息
J Nutr Health Aging. 2010 Jan;14(1):57-61. doi: 10.1007/s12603-010-0010-4.
OBJECTIVES
Evaluate the impact of educational intervention in decreasing ADEs in elderly patients in a hospital setting.
DESIGN
Randomised prospective study.
SETTING
The study was performed in France in the Paris area, in 16 rehabilitation geriatric centres of APHP (Assistance Publique - Hôpitaux de Paris). Patient capacity per centre varied from 15 to 57 with a total of 526.
PARTICIPANTS
All the patients > or = 65 years hospitalized during the 4 week study period were included.
MEASUREMENTS
During a first 2 week phase without intervention ADE's were recorded in all centres. Then units were then randomised for an educational intervention or not. The educational phase lasted 1 week, without ADE tracking. Then, both types of units (I+ and I-) recorded ADEs for 2 weeks. Possible drug-related incidents were detected using a standardized check list (nurses) and a weekly review of all charts by investigators. Possible drug-related incidents were analysed by a group of reviewers selected from the authors to classify them as ADE or not.
RESULTS
576 patients (mean age: 83.6 +/- 7.9 years) were consecutively included. The mean number of drugs at inclusion was 9.4 +/- 4.24 drugs per patient. 223 out of 755 events were considered "probable" ADEs (29.5%). Among the 223 ADEs, 62 (28%) could have been prevented. The main outcome of this trial was the change in the proportion of ADEs in elderly patients in the intervention-units, compared to the control group. The main errors were: to high a dose (26%), double therapy (21%), under dose (13%), inappropriate drug (13%), drug-drug interaction (6%), previous same adverse drug reaction (3%) and miscellaneous (11.18%). After a specific educational intervention program, there were fewer ADEs in the intervention group (n = 38, 22%) than in the control group (n = 63, 36%; p = 0.004).
CONCLUSION
Educational programs could help reduce the prevalence of ADEs by 14% and encourage physicians to change outdated prescription habits.
目的
评估在医院环境中对老年患者进行教育干预以减少 ADE 的效果。
设计
随机前瞻性研究。
地点
这项研究在法国巴黎地区的 16 家 APHP（巴黎公立医院集团）康复老年医学中心进行。每个中心的患者容纳量从 15 人到 57 人不等，总共 526 人。
参与者
所有在 4 周研究期间住院的年龄≥65 岁的患者均被纳入。
测量
在没有干预的第一阶段（2 周），所有中心均记录 ADE。然后，单位随机接受或不接受教育干预。教育阶段持续 1 周，不跟踪 ADE。然后，两种类型的单位（I+和 I-）均记录了 2 周的 ADE。使用标准化检查表（护士）和调查员每周审查所有图表来检测可能的药物相关事件。由作者挑选的一组评审员对可能的药物相关事件进行分析，以将其归类为 ADE 或非 ADE。
结果
连续纳入 576 名患者（平均年龄：83.6±7.9 岁）。纳入时平均药物数量为 9.4±4.24 种药物/患者。755 项事件中有 223 项被认为是“可能”的 ADE（29.5%）。在这 223 项 ADE 中，有 62 项（28%）是可以预防的。该试验的主要结果是干预组与对照组相比，老年患者中 ADE 的比例变化。主要错误是：剂量过高（26%）、双重疗法（21%）、剂量不足（13%）、药物不当（13%）、药物相互作用（6%）、先前相同的药物不良反应（3%）和杂项（11.18%）。在特定的教育干预计划后，干预组的 ADE 较少（n=38，22%），而对照组的 ADE 较多（n=63，36%；p=0.004）。
结论
教育计划可以帮助减少 14%的 ADE 发生率，并鼓励医生改变过时的处方习惯。
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