Pharmacy Department, Austin Health, Studley Rd, Heidelberg, VIC, 3084, Australia.
Int J Clin Pharm. 2013 Apr;35(2):217-24. doi: 10.1007/s11096-012-9730-3. Epub 2012 Dec 5.
Hospitalisation often leads to increased medication regimen complexity for older patients; increased complexity is associated with medication non-adherence. There has been little research into strategies for reducing the impact of hospitalisation on medication regimen complexity.
To investigate the impact of pharmacist medication review, together with an educational intervention targeting clinical pharmacists and junior medical officers, on the increase in medication regimen complexity that occurs during hospitalisation.
Two acute general medicine wards and two subacute aged care (geriatric assessment and rehabilitation) wards at a major metropolitan public hospital in Melbourne, Australia.
A before-after study involving patients aged 60 years and over was undertaken over two 5-week periods. During the pre-intervention period patients received usual care. During the intervention period, clinical pharmacists were encouraged to review patients' medication regimen complexity prior to discharge, and make recommendations to hospital medical officers to simplify regimens. Prior to the intervention period, pharmacists attended an interactive case-based education session about medication regimen simplification, and completed an assessment task. A similar, but briefer, education session was delivered to junior medical officers.
The primary endpoint was change in medication regimen complexity index (MRCI) score (a validated measure of regimen complexity) between admission and discharge for regularly scheduled long-term medications, adjusted for age, length of hospital stay, number of medications and regimen complexity prior to admission.
Three hundred ninety-one patients were included (mean age 80.6 years, mean 7.4 regularly scheduled long-term medications on admission). The mean increase in MRCI score between admission and discharge was significantly smaller in the 205 intervention patients than in the 186 usual care patients (2.5 vs. 4.0, p = 0.02; adjusted difference 1.6, 95 %CI 0.3, 2.9). The intervention had greatest impact in patients discharged from subacute wards (mean adjusted difference: 2.7), not using a dose administration aid after discharge (mean adjusted difference: 2.6), and not discharged to a residential care facility (mean adjusted difference: 1.9). Mean differences in MRCI scores were equivalent to ceasing one to two medications.
An educational intervention and clinical pharmacist medication review reduced the impact of hospitalisation on the complexity of older patients' medication regimens.
住院常常会增加老年患者的药物治疗方案的复杂性；复杂性的增加与药物不依从有关。针对减少住院对药物治疗方案复杂性影响的策略，研究甚少。
调查药师进行药物审查，以及对临床药师和初级医生进行教育干预，对住院期间药物治疗方案复杂性增加的影响。
在澳大利亚墨尔本一家主要的大都市公立医院的两个急性内科病房和两个亚急性老年护理（老年评估和康复）病房进行了一项前后对照研究。
在两个为期 5 周的阶段中，对 60 岁及以上的患者进行了一项前瞻性研究。在干预前阶段，患者接受常规护理。在干预阶段，临床药师鼓励在出院前审查患者的药物治疗方案复杂性，并向医院医生提出简化方案的建议。在干预前阶段，药师参加了一次关于简化药物治疗方案的互动案例教育课程，并完成了一项评估任务。向初级医生提供了类似但更简短的教育课程。
主要终点是调整年龄、住院时间、入院时药物数量和入院时治疗方案复杂性后，定期长期药物治疗方案入院时和出院时的药物治疗方案复杂性指数（MRCI）评分的变化。
共纳入 391 例患者（平均年龄 80.6 岁，入院时平均有 7.4 种定期长期药物）。与常规护理组的 186 例患者相比，干预组的 205 例患者的 MRCI 评分在入院和出院之间的平均增加幅度显著较小（2.5 与 4.0，p = 0.02；调整后的差异为 1.6，95%CI 0.3，2.9）。该干预措施对从亚急性病房出院的患者（平均调整后的差异：2.7）、出院后不使用剂量给药辅助工具的患者（平均调整后的差异：2.6）和不转至养老院的患者（平均调整后的差异：1.9）影响最大。MRCI 评分的平均差异相当于停用一到两种药物。
教育干预和临床药师药物审查减少了住院对老年患者药物治疗方案复杂性的影响。
