一项利用药物负担指数减少老年人抗胆碱能和镇静药物暴露的初步随机临床试验。
A pilot randomized clinical trial utilizing the drug burden index to reduce exposure to anticholinergic and sedative medications in older people.
机构信息
Clinical Pharmacology Department, University of Sydney, St Leonards, New South Wales, Australia.
出版信息
Ann Pharmacother. 2010 Nov;44(11):1725-32. doi: 10.1345/aph.1P310. Epub 2010 Sep 28.
BACKGROUND
The drug burden index (DBI) is an evidence-based tool that utilizes pharmacologic principles to calculate an individual's total exposure to anticholinergic and sedative medications. Higher DBI has been associated with functional impairment in observational studies of older people.
OBJECTIVE
To assess the impact of providing information about DBI to general practitioners (GPs) on prescribing for older people.
METHODS
This was a cluster randomized controlled trial with 3 months of follow-up. Participants were volunteers aged ≥70 years, living in self-care retirement villages in Sydney, Australia. The study intervention involved a letter and phone call to GPs, using DBI to prompt them to consider cessation or dose reduction of anticholinergic and sedative medications. The primary study outcome was to assess the impact of information about DBI on prescribing practices of the GPs.
RESULTS
A total of 115 participants were enrolled, 57 in the intervention group (from 6 sites) and 58 in the control group (from 6 sites). At baseline, 19 of 57 participants in the intervention group and 31 of 58 participants in the control group had a DBI >0 (p < 0.05). At follow-up, a DBI change was observed in 16 participants. DBI decreased in 12 participants, 6 (32%) in the intervention group, and 6 (19%) in the control group. GPs identified the following barriers to reducing anticholinergic and sedative drugs: uncomfortable altering prescriptions initiated by specialists; unable to influence patients' attitudes; unaware of patients' medications and strong clinical indication.
CONCLUSIONS
The intervention targeting GPs' prescribing practices was less effective than anticipated in reducing anticholinergic and sedative drug exposure, and barriers were identified. Future studies should explore multidisciplinary interventions, engaging patients, specialists, GPs, and pharmacists.
背景
药物负担指数（DBI）是一种基于证据的工具，利用药理学原理计算个体接触抗胆碱能和镇静药物的总量。观察性研究表明，较高的 DBI 与老年人的功能障碍有关。
目的
评估向全科医生（GP）提供 DBI 信息对老年人处方的影响。
方法
这是一项为期 3 个月随访的集群随机对照试验。参与者为年龄≥70 岁、居住在澳大利亚悉尼自理退休村的志愿者。研究干预措施包括给 GP 寄信和打电话，使用 DBI 提示他们考虑停止或减少使用抗胆碱能和镇静药物。主要研究结果是评估 DBI 信息对 GP 处方实践的影响。
结果
共纳入 115 名参与者，干预组 57 名（来自 6 个地点），对照组 58 名（来自 6 个地点）。基线时，干预组 57 名参与者中有 19 名（p<0.05）和对照组 58 名参与者中有 31 名（p<0.05）的 DBI>0。随访时，16 名参与者的 DBI 发生变化。DBI 降低的有 12 名参与者，干预组 6 名（32%），对照组 6 名（19%）。GP 确定了减少抗胆碱能和镇静药物的以下障碍：改变专科医生开始的处方不舒服；无法影响患者的态度；不知道患者的药物和强烈的临床指征。
结论
针对 GP 处方实践的干预措施降低抗胆碱能和镇静药物暴露的效果不如预期，并且确定了障碍。未来的研究应探索多学科干预措施，让患者、专科医生、GP 和药剂师共同参与。
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