Department of Family Medicine, University of Ottawa, Ontario.
Can Fam Physician. 2012 Aug;58(8):862-8.
To measure the effect of nurse practitioner and pharmacist consultations on the appropriate use of medications by patients.
We studied patients in the intervention arm of a randomized controlled trial. The main trial intervention was provision of multidisciplinary team care and the main outcome was quality and processes of care for chronic disease management.
Patients were recruited from a single publicly funded family health network practice of 8 family physicians and associated staff serving 10 000 patients in a rural area near Ottawa, Ont.
A total of 120 patients 50 years of age or older who were on the practice roster and who were considered by their family physicians to be at risk of experiencing adverse health outcomes.
A pharmacist and 1 of 3 nurse practitioners visited each patient at his or her home, conducted a comprehensive medication review, and developed a tailored plan to optimize medication use. The plan was developed in consultation with the patient and the patient's doctor. We assessed medication appropriateness at the study baseline and again 12 to 18 months later.
We used the medication appropriateness index to assess medication use. We examined associations between personal characteristics and inappropriate use at baseline and with improvements in medication use at the follow-up assessment. We recorded all drug problems encountered during the trial.
At baseline, 27.2% of medications were inappropriate in some way and 77.7% of patients were receiving at least 1 medication that was inappropriate in some way. At the follow-up assessments these percentages had dropped to 8.9% and 38.6%, respectively (P < .001). Patient characteristics that were associated with receiving inappropriate medication at baseline were being older than 80 years of age (odds ratio [OR] = 5.00, 95% CI 1.19 to 20.50), receiving more than 4 medications (OR = 6.64, 95% CI 2.54 to 17.4), and not having a university-level education (OR = 4.55, 95% CI 1.69 to 12.50).
We observed large improvements in the appropriate use of medications during this trial. This might provide a mechanism to explain some of the reductions in mortality and morbidity observed in other trials of counseling and advice provided by pharmacists and nurses.
NCT00238836 (ClinicalTrials.gov).
测量护士从业者和药剂师咨询对患者药物使用的适当性的影响。
我们研究了随机对照试验干预组的患者。主要试验干预措施是提供多学科团队护理，主要结果是慢性病管理的护理质量和流程。
患者从安大略省渥太华附近一个农村地区的一个由 8 名家庭医生和相关工作人员组成的单一公共资助家庭医疗网络实践中招募，为 10000 名患者提供服务。
共有 120 名年龄在 50 岁或以上的患者，他们在该实践名单上，并且被他们的家庭医生认为有经历不良健康结果的风险。
一名药剂师和 3 名护士从业者中的 1 名到每位患者的家中进行全面的药物审查，并制定了优化药物使用的定制计划。该计划是在与患者和患者的医生协商后制定的。我们在研究基线时和 12 至 18 个月后评估药物的适当性。
我们使用药物适当性指数评估药物使用情况。我们检查了个人特征与基线时的不适当使用以及随访评估中药物使用改善之间的关联。我们记录了试验期间遇到的所有药物问题。
在基线时，27.2%的药物在某种程度上不适当，77.7%的患者至少有一种在某种程度上不适当的药物。在随访评估中，这些百分比分别降至 8.9%和 38.6%（P<.001）。与基线时接受不适当药物治疗相关的患者特征为年龄大于 80 岁（比值比[OR] = 5.00，95%CI 1.19 至 20.50）、接受超过 4 种药物（OR = 6.64，95%CI 2.54 至 17.4）和没有大学学历（OR = 4.55，95%CI 1.69 至 12.50）。
我们在这项试验中观察到药物使用的适当性有了很大的提高。这可能为解释在其他由药剂师和护士提供咨询和建议的试验中观察到的死亡率和发病率降低提供了一种机制。
NCT00238836（ClinicalTrials.gov）。
