Clinical Pharmacology Department, Clinical Center, and Medical Faculty, University of Kragujevac, Ul. Svetozara Markovica 69, 34000 Kragujevac, Serbia.
Eur J Clin Pharmacol. 2011 Nov;67(11):1091-101. doi: 10.1007/s00228-011-1059-7. Epub 2011 May 14.
To evaluate the influence of the pharmacological profile of a patient (PPP) on quality of drug prescribing, treatment effectiveness, safety, and health services utilization in a group of outpatients.
The study was designed as an open, nonrandomized trial of an intervention in health care. The outpatient intervention group (n = 39) received the PPP, and the control group (n = 36) did not. In all cases, the outcomes were observed for a 2-year period in total; in the intervention group 1 year of observation was allocated before and another year after the introduction of the PPP.
The PPPs reduced multiple prescriptions by 1.08 ± 1.13 drugs per patient, whereas in those who did not receive the PPP, an increase of 1.44 ± 1.48 drugs per patient occurred (P < 0.001, 95% CI 1.91-3.13). A decrease in the medication appropriateness index score of 0.81 ± 0.51 per drug per patient in the intervention group was observed (P = 0.001, 95% CI 0.63-0.93), and in the control group an increase was noted (0.13 ± 0.40; P = 0.063). The majority of patients with PPP experienced fewer adverse drug reactions (0.96 ± 0.58 fewer, P < 0.001 vs. controls, 95% CI 1.39-2.13), and they were more likely to have an improvement in health status (OR 22.0, 95% CI 5.87-82.41). Finally, the PPPs decreased both the number of examinations and the number of diagnostic investigations, on average by 2.15 and 2.26 services per patient, respectively.
Use of a pharmacological profile of a patient in primary care practice could improve not only prescribing behavior of general practitioners, but also effectiveness and safety of therapy, while reducing utilization of health services.
评估患者药理学概况(PPP)对一组门诊患者药物处方质量、治疗效果、安全性和卫生服务利用的影响。
该研究设计为医疗保健干预的开放、非随机试验。门诊干预组(n=39)接受 PPP,对照组(n=36)未接受。在所有情况下,总共有 2 年的观察期;在干预组中,在引入 PPP 之前和之后各观察 1 年。
PPP 使每位患者的多种药物处方减少了 1.08±1.13 种,而在未接受 PPP 的患者中,每位患者的药物处方增加了 1.44±1.48 种(P<0.001,95%CI 1.91-3.13)。干预组药物适宜指数评分每药物每患者降低 0.81±0.51 分(P=0.001,95%CI 0.63-0.93),对照组则升高(0.13±0.40;P=0.063)。大多数接受 PPP 的患者不良反应更少(0.96±0.58,P<0.001,95%CI 1.39-2.13),健康状况改善的可能性更高(OR 22.0,95%CI 5.87-82.41)。最后,PPP 平均减少了 2.15 次检查和 2.26 次诊断检查,分别减少了每位患者的服务次数。
在初级保健实践中使用患者的药理学概况不仅可以改善全科医生的处方行为,还可以提高治疗效果和安全性,同时减少卫生服务的利用。