[一项减少β受体阻滞剂和钙通道阻滞剂潜在不适当处方的干预措施的结果]
[Results of an intervention to reduce potentially inappropriate prescriptions of beta blockers and calcium channel blockers].
作者信息
Machado-Alba J E, Giraldo-Giraldo C, Aguirre Novoa A
机构信息
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Departamento de Ciencias Básicas, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.
出版信息
Rev Calid Asist. 2016 May-Jun;31(3):134-40. doi: 10.1016/j.cali.2015.09.008. Epub 2015 Dec 18.
OBJECTIVE
To determine the frequency of simultaneous prescription of β-blockers and calcium channel blockers, notify the cardiovascular risk of these patients to the health care professionals in charge of them, and achieve a reduction in the number of those who use them.
METHODS
Quasi-experimental, prospective study by developing an intervention on medical prescriptions of patients older than 65 years treated between January 1 and July 30, 2014, affiliated to the Health System in 101 cities in Colombia. A total of 43,180 patients received a β-blocker each month, and 14,560 receiving a calcium channel blocker were identified. Educational interventions were performed and an evaluation was made, using sociodemographic and pharmacological variables, on the number of patients that stopped taking any of the two drugs in the following three months.
RESULTS
A total of 535 patients, with a mean age 75.8±6.7 years received concomitant β-blockers plus calcium channel blockers. Modification of therapy was achieved in 235 patients (43.9% of users) after 66 educational interventions. In 209 cases (88.9%) one of the two drugs was suspended, and 11.1% changed to other antihypertensive drugs. The variable of being more than 85 years old (OR: 1.93; 95% CI: 1.07-3.50), and receiving concomitant medication with inhibitors of the renin-angiotensin system (OR: 2.16; 95% CI: 1.28-3.65) were associated with increased risk of their doctor changing or stopping the prescription.
CONCLUSIONS
An improved adherence to recommendations for appropriate use of β-blockers and calcium channel blockers by health service providers was achieved. Intervention programs that reduce potentially inappropriate prescriptions for patients treated for cardiovascular disease should be used more frequently.
目的
确定β受体阻滞剂和钙通道阻滞剂联合处方的频率,将这些患者的心血管风险告知负责治疗的医护人员,并减少使用这两种药物的患者数量。
方法
采用准实验性前瞻性研究,对2014年1月1日至7月30日期间在哥伦比亚101个城市卫生系统接受治疗的65岁以上患者的医疗处方进行干预。每月共有43180名患者接受β受体阻滞剂治疗,确定14560名接受钙通道阻滞剂治疗的患者。进行了教育干预,并使用社会人口统计学和药理学变量对接下来三个月内停止服用这两种药物中任何一种的患者数量进行了评估。
结果
共有535名平均年龄为75.8±6.7岁的患者同时接受β受体阻滞剂和钙通道阻滞剂治疗。经过66次教育干预后,235名患者(占使用者的43.9%)实现了治疗方案的调整。在209例(88.9%)中,停用了两种药物中的一种,11.1%更换为其他降压药物。年龄超过85岁(比值比:1.93;95%置信区间:1.07 - 3.50)以及同时接受肾素 - 血管紧张素系统抑制剂治疗(比值比:2.16;95%置信区间:1.28 - 3.65)这两个变量与医生更改或停止处方的风险增加相关。
结论
医护人员对β受体阻滞剂和钙通道阻滞剂合理使用建议的依从性得到了提高。应更频繁地使用减少心血管疾病患者潜在不适当处方的干预项目。