Pharmacie interjurassienne, Hospitals and Nursing homes of Jura and Jura bernois SA, Beausite 49, 2740 Moutier, Switzerland.
Int J Clin Pharm. 2011 Jun;33(3):549-57. doi: 10.1007/s11096-011-9506-1. Epub 2011 Mar 26.
The objective of this study was to assess implementation of a pharmaceutical care model for the multidisciplinary care of elderly patients in nursing homes.
Prospective study, medication review, from January 2007 to December 2009 in ten nursing homes affiliated to the Pharmacie interjurassienne (PIJ), Switzerland.
Medication use data were collected and reviewed by a pharmacist, focusing on drug indication, dosing, side effects, renal/hepatic elimination and interactions. Drug-related problems (DRPs) were discussed face-to-face with the responsible physician and a nurse. The pharmaceutical care issues were formulated and medication interventions proposed during this meeting. DRPs and interventions were documented using the Pharmaceutical Care Network Europe scheme version 5.00 (PCNE V5.00). The economic impact of the service was estimated through a retrospective evaluation of annual drug costs. A satisfaction evaluation was conducted among practitioners and nurses.
DRPs, interventions, treatment changes implemented.
Drug therapy of 329 patients was reviewed. The number of medicines per patient ranged from 2 to 27 (mean 12.8). A total of 1,225 DRPs were detected and discussed with the physician and the nurse. Medication review led to 343 medical evaluations secondary to drug-drug interactions and 803 treatment adaptations: 373 drugs were stopped, 197 dosages changed, 95 instructions for use amended, 86 drug choices were altered, 35 drug formulations changed and 17 new drugs started. According to the Anatomical Classification System, the main classes involved in interventions were related to Alimentary tract and metabolism (n = 285), Nervous system (n = 189) and Cardiovascular system (n = 115). Since the outset of the PIJ, the annual drug costs decreased in nursing homes with medication review including a pharmacist, whereas it was stable in the other nursing homes. The satisfaction evaluation showed a very positive appreciation by practitioners and nurses.
The study showed an efficient pharmaceutical care model, well accepted by physicians and nurses. It also indicated that for elderly patients, continuous drug review contributed to improved drug therapy, reduced unnecessary polypharmacy and reduced pharmaceutical costs.
本研究旨在评估在养老院中为多学科护理老年患者实施药学服务模式的实施情况。
前瞻性研究，药物评估，2007 年 1 月至 2009 年 12 月，瑞士 Pharmacie interjurassienne（PIJ）的 10 家养老院。
药物使用数据由药剂师收集和评估，重点关注药物适应证、剂量、副作用、肾/肝清除率和相互作用。药物相关问题（DRP）与负责的医生和护士进行面对面讨论。在会议上制定了药学服务问题并提出了药物干预措施。使用欧洲药学保健网络方案 5.00 版（PCNE V5.00）记录药物相关问题和干预措施。通过对年度药物成本的回顾性评估来估计服务的经济影响。对医生和护士进行了满意度评估。
药物相关问题、干预措施、实施的治疗改变。
共评估了 329 名患者的药物治疗。每位患者的药物数量从 2 种到 27 种（平均 12.8 种）不等。共发现并与医生和护士讨论了 1225 个药物相关问题。药物审查导致 343 次因药物相互作用和 803 次治疗调整的医学评估：停止 373 种药物，改变 197 种剂量，修改 95 种使用说明，改变 86 种药物选择，改变 35 种药物制剂，开始使用 17 种新药。根据解剖分类系统，干预措施主要涉及消化道和代谢（n = 285）、神经系统（n = 189）和心血管系统（n = 115）。自 PIJ 成立以来，在包括药剂师在内的养老院中，药物审查后的年度药物费用下降，而在其他养老院中则保持稳定。满意度评估显示医生和护士对该模型给予了非常积极的评价。
该研究表明了一种高效的药学服务模式，深受医生和护士的欢迎。它还表明，对于老年患者，持续的药物审查有助于改善药物治疗，减少不必要的多种药物并用，并降低药物成本。
