Elliott Rohan A, Woodward Michael C
Pharmacy Department, Austin Health, Heidelberg.
Australas J Ageing. 2011 Sep;30(3):124-9. doi: 10.1111/j.1741-6612.2010.00458.x. Epub 2010 Aug 19.
To investigate the prevalence of medication-related problems (MRPs) in patients attending aged care and memory disorder clinics and explore the potential role of a clinical pharmacist to obtain medication histories and identify unresolved MRPs.
The clinical pharmacist interviewed patients and reviewed their medication regimens in the outpatient clinics. Clinical significance of pharmacist-identified MRPs was rated by an independent expert panel using validated criteria.
Forty-six patients (mean age 82 years) were reviewed. They took a median of nine medications, of which three were not recorded in the medical record. One hundred and thirteen MRPs (median 2.0 per patient) were identified by the pharmacist. Independent review rated 35% of MRPs as high or extreme risk. Thirty-seven (33%) MRPs related to medications not recorded in the medical record.
Medication-related problems were present for most patients. Involvement of a clinical pharmacist resulted in a more comprehensive medication history and identified unresolved MRPs.
调查老年护理和记忆障碍门诊患者中与药物相关问题（MRP）的发生率，并探讨临床药师获取用药史和识别未解决的MRP的潜在作用。
临床药师在门诊对患者进行访谈并审查其用药方案。由独立专家小组使用经过验证的标准对药师识别出的MRP的临床意义进行评级。
共审查了46例患者（平均年龄82岁）。他们平均服用9种药物，其中3种未记录在病历中。药师识别出113个MRP（每位患者中位数为2.0个）。独立审查将35%的MRP评为高风险或极高风险。37个（33%）MRP与未记录在病历中的药物有关。
大多数患者存在与药物相关的问题。临床药师的参与带来了更全面的用药史，并识别出未解决的MRP。
