Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, Utrecht, The Netherlands; Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
J Am Geriatr Soc. 2014 Jul;62(7):1353-9. doi: 10.1111/jgs.12884. Epub 2014 Jun 10.
Medical students may not be adequately trained to prescribe appropriately to older adults with polypharmacy. This study addressed how to teach students to minimize inappropriate polypharmacy. Final-year medical students (N = 106) from two Dutch schools of medicine participated in this randomized controlled trial with a pre/posttest design. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) was used as the intervention. This medication review tool consists of five steps and is part of the Dutch multidisciplinary guideline on polypharmacy. Step two is a structured pharmaceutical analysis of drug use, assessed using six questions regarding undertreatment, ineffective treatment, overtreatment, potential adverse effects, contraindications or interactions, and dose adjustments. It is used in combination with the Screening Tool to Alert doctors to Right Treatment and the Screening Tool of Older Person's Prescriptions checklists. Students were asked to optimize the medication lists of real people, making use, or not, of the STRIP. The number of correct or potentially harmful decisions that the students made when revising the lists was determined by comparison with expert consensus. Students who used the STRIP had better scores than control students; they made more correct decisions (9.3 vs 7.0, 34%; P < .001, correlation coefficient (r) = 0.365) and fewer potentially harmful decisions (3.9 vs 5.6, -30%; P < .001, r = 0.386). E-learning did not have a different effect from that of non-E-learning methods. Students were satisfied with the method. The STRIP method is effective in helping final-year medical students improve their prescribing skills.
医学生可能没有接受充分的培训，无法为服用多种药物的老年患者开具合适的处方。本研究旨在探讨如何教授学生尽量减少不适当的多重用药。来自荷兰两所医学院的 106 名应届医学生参与了这项随机对照试验，采用前后测试设计。干预措施是使用系统减少不适当处方工具（STRIP）。该药物评估工具包含五个步骤，是荷兰多学科多重用药指南的一部分。第二步是对药物使用进行结构化的药物分析，通过六个问题评估，分别是治疗不足、无效治疗、过度治疗、潜在不良反应、禁忌证或相互作用以及剂量调整。它与医生正确治疗警报筛选工具（Screening Tool to Alert doctors to Right Treatment）和老年人用药筛选清单（Screening Tool of Older Person's Prescriptions checklists）联合使用。学生被要求优化真实患者的用药清单，在使用或不使用 STRIP 的情况下进行调整。通过与专家共识进行比较，确定学生在修订清单时做出的正确或潜在有害决策的数量。使用 STRIP 的学生的得分高于对照组学生；他们做出了更多正确的决策（9.3 比 7.0，34%；P<0.001，相关系数（r）=0.365）和更少的潜在有害决策（3.9 比 5.6，-30%；P<0.001，r=0.386）。电子学习与非电子学习方法的效果没有差异。学生对该方法表示满意。STRIP 方法有助于提高应届医学生的处方技能。
