Department of Pharmacology and Toxicology, University of Kuopio, Kuopio, Finland.
Drugs Aging. 2010 Jun 1;27(6):507-21. doi: 10.2165/11536650-000000000-00000.
High drug consumption among the elderly and inappropriate prescribing practices increase the risk of adverse drug effects in this population. This risk may be decreased by conducting, for example, a medication review alone or as part of a comprehensive geriatric assessment (CGA); however, little is known about the fate of the changes in medication made as a result of the CGA or medication review. To study the performance of the CGA with regards to medication changes and to determine the persistence of these changes over a 1-year period. This study was a population-based intervention study. A random sample of 1000 elderly (age > or =75 years) was randomized either to a CGA group or to a control group. Home-dwelling patients from these groups (n = 331 and n = 313 for intervention and control groups, respectively) were analysed in this study. Study nurses collected information on medication at study entry and 1 year later in both groups; in the intervention group, study physicians assessed, and changed when appropriate, the medication at study entry. The medication changes and their persistence over 1 year were then evaluated. Medication changes were more frequent in the intervention group than in the control group. Regular medication was changed during follow-up in 277 (83.7%) and in 228 (72.8%) [odds ratio (OR) 1.9; 95% CI 1.3, 2.8] patients in the intervention and control groups, respectively. In the intervention group, study physicians were responsible for 35.4% of all new prescriptions and for 15.6% of all drug terminations. Changes took place particularly in the prescription of CNS drugs. About 58% of the drugs initiated by study physicians were still in use 1 year later, and 25.5% of those terminated by study physicians had been reintroduced. Drug intervention as part of a CGA can be used to rationalize the drug therapy of a patient. However, its effectiveness is subsequently partly counteracted by other physicians working in the healthcare system.
老年人药物消耗量大且处方不当会增加该人群发生药物不良反应的风险。例如，仅进行药物审查或作为综合老年评估（CGA）的一部分，可降低这种风险；然而，人们对 CGA 或药物审查后药物调整的结果知之甚少。本研究旨在评估 CGA 在药物调整方面的表现，并确定这些调整在 1 年内的持续情况。本研究为基于人群的干预研究。对 1000 名（年龄≥75 岁）老年人进行随机抽样，分为 CGA 组和对照组。对这两组的居家患者（干预组 n=331，对照组 n=313）进行了分析。研究护士在两组均于研究入组时和 1 年后收集药物信息；在干预组，研究医生在研究入组时评估并酌情调整药物。然后评估药物调整及其在 1 年内的持续情况。干预组的药物调整比对照组更频繁。在随访期间，干预组有 277 名（83.7%）和 228 名（72.8%）患者（优势比 [OR] 1.9；95%可信区间 [CI] 1.3，2.8）需要调整常规药物，而对照组分别有 277 名（83.7%）和 228 名（72.8%）患者（OR 1.9；95%CI 1.3，2.8）需要调整常规药物。在干预组中，研究医生负责开具所有新处方的 35.4%和所有停药的 15.6%。调整主要发生在 CNS 药物的处方上。研究医生开的药中有 58%在 1 年后仍在使用，而研究医生停药中有 25.5%重新引入。CGA 中的药物干预可用于合理调整患者的药物治疗。然而，其效果随后会被医疗系统中的其他医生部分抵消。
