Basger Benjamin J, Moles Rebekah J, Chen Timothy F
Faculty of Pharmacy, The University of Sydney, A15 Science Road, Sydney, Camperdown, NSW, 2006, Australia.
Int J Clin Pharm. 2015 Dec;37(6):1194-205. doi: 10.1007/s11096-015-0186-0. Epub 2015 Aug 22.
Older people are at increased risk of drug-related problems (DRPs) caused by inappropriate use or underuse of medications which may be increased during care transitions.
To examine the effects of applying a validated prescribing appropriateness criteria-set during medication review in a cohort of older (≥65 years) Australians at the time of discharge from hospital.
Private hospital and homes of older patients in Sydney, Australia.
Cognitively well English speaking patients aged 65 years or over taking five or more medications were recruited. A prescribing appropriateness criteria-set and SF-36 health-related quality of life health (HRQoL) survey were applied to all patients at discharge. Patients were then randomly assigned to receive either usual care (control, n = 91) or discharge medication counselling and a medication review by a clinical pharmacist (intervention, n = 92). Medication review recommendations were sent to the general practitioners of intervention group patients. All patients were followed up at 3 months post discharge, where the prescribing appropriateness criteria-set was reapplied and HRQoL survey repeated. MAIN OUTCOME MEASURES change in the number of prescribing appropriateness criteria met; change in HRQoL; number and causes of DRPS identified by medication review; intervention patient medication recommendation implementation rates.
There was no significant difference in the number of criteria applicable and met in intervention patients, compared to control patients, between follow-up and discharge (0.09 ≤ p ≤ 0.97). While the difference between groups was positive at follow-up for SF-36 scores, the only domain that reached statistical significance was that for vitality (p = 0.04). Eighty-eight intervention patient medication reviews identified 750 causes of DRPs (8.5 ± 2.7 per patient). No causes of DRPs were identified in four patients. Of these causes, 76.4 % (573/750) were identified by application of the prescribing appropriateness criteria-set. GPs implemented a relatively low number (42.4 %, 318/750) of recommendations.
Application of a prescribing appropriateness criteria-set during medication review in intervention patients did not increase the number of criteria met, nor result in a significant improvement in HRQoL. Higher recommendation implementation rates may require additional facilitators, including a higher quality of collaboration.
老年人因用药不当或用药不足而出现药物相关问题（DRP）的风险增加，在护理过渡期间这种风险可能会进一步上升。
研究在澳大利亚一组老年（≥65岁）患者出院时，在药物审查过程中应用经过验证的处方适宜性标准集的效果。
澳大利亚悉尼的私立医院和老年患者家中。
招募认知功能良好、说英语、年龄在65岁及以上且服用五种或更多药物的患者。在出院时对所有患者应用处方适宜性标准集和SF-36健康相关生活质量（HRQoL）调查问卷。然后将患者随机分为两组，一组接受常规护理（对照组，n = 91），另一组接受出院药物咨询并由临床药剂师进行药物审查（干预组，n = 92）。将药物审查建议发送给干预组患者的全科医生。所有患者在出院后3个月进行随访，再次应用处方适宜性标准集并重复进行HRQoL调查。主要观察指标：达到的处方适宜性标准数量的变化；HRQoL的变化；通过药物审查确定的DRP的数量和原因；干预组患者药物建议的实施率。
在随访和出院时，与对照组患者相比，干预组患者适用和达到的标准数量没有显著差异（0.09≤p≤0.97）。虽然随访时两组在SF-36评分上的差异为正向，但唯一达到统计学显著性的领域是活力（p = 0.04）。对88例干预组患者的药物审查确定了750个DRP原因（每位患者8.5±2.7个）。4例患者未发现DRP原因。在这些原因中，76.4%（573/750）是通过应用处方适宜性标准集确定的。全科医生实施的建议数量相对较低（42.4%，318/750）。
在干预组患者的药物审查过程中应用处方适宜性标准集，并没有增加达到的标准数量，也没有使HRQoL得到显著改善。更高的建议实施率可能需要额外的促进因素，包括更高质量的协作。
