Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany.
BMC Fam Pract. 2012 Sep 6;13:91. doi: 10.1186/1471-2296-13-91.
Patients with chronic kidney disease (CKD) are at increased risk for inappropriate or potentially harmful prescribing. The aim of this study was to examine whether a multifaceted intervention including the use of a software programme for the estimation of creatinine clearance and recommendation of individual dosage requirements may improve correct dosage adjustment of relevant medications for patients with CKD in primary care.
A cluster-randomized controlled trial was conducted between January and December 2007 in small primary care practices in Germany. Practices were randomly allocated to intervention or control groups. In each practice, we included patients with known CKD and elderly patients (≥70 years) suffering from hypertension. The practices in the intervention group received interactive training and were provided a software programme to assist with individual dose adjustment. The control group performed usual care. Data were collected at baseline and at 6 months. The outcome measures, analyzed across individual patients, included prescriptions exceeding recommended maximum daily doses, with the primary outcome being prescriptions exceeding recommended standard daily doses by more than 30%.
Data from 44 general practitioners and 404 patients are included. The intervention was effective in reducing prescriptions exceeding the maximum daily dose per patients, with a trend in reducing prescriptions exceeding the standard daily dose by more than 30%.
A multifaceted intervention including the use of a software program effectively reduced inappropriately high doses of renally excreted medications in patients with CKD in the setting of small primary care practices.
Current Controlled Trials ISRCTN02900734.
慢性肾脏病（CKD）患者发生不适当或潜在有害处方的风险增加。本研究旨在探讨一种多方面的干预措施，包括使用估算肌酐清除率的软件程序和推荐个体化剂量要求，是否可以改善初级保健中 CKD 患者相关药物的正确剂量调整。
这是一项在德国小型初级保健机构中于 2007 年 1 月至 12 月间进行的群组随机对照试验。各机构被随机分配至干预组或对照组。在每个机构中，我们纳入已知患有 CKD 的患者和患有高血压的老年患者（≥70 岁）。干预组接受了互动培训，并提供了一个软件程序以协助进行个体化剂量调整。对照组则进行常规护理。数据在基线和 6 个月时收集。分析指标为超过推荐最大日剂量的处方，主要结局指标为超过推荐标准日剂量 30%以上的处方。
共纳入 44 名全科医生和 404 名患者的数据。干预措施有效地减少了每位患者超过最大日剂量的处方，且有减少超过标准日剂量 30%以上处方的趋势。
一种多方面的干预措施，包括使用软件程序，可以有效地减少小型初级保健机构中 CKD 患者中肾排泄药物的不适当高剂量。
当前对照试验 ISRCTN02900734。
