Cossette Benoit, Bergeron Josée, Ricard Geneviève, Éthier Jean-François, Joly-Mischlich Thomas, Levine Mitchell, Sene Modou, Mallet Louise, Lanthier Luc, Payette Hélène, Rodrigue Marie-Claude, Brazeau Serge
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Research Centre on Aging, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
J Am Geriatr Soc. 2016 Dec;64(12):2487-2494. doi: 10.1111/jgs.14322. Epub 2016 Sep 2.
To evaluate the effect of a knowledge translation (KT) strategy to reduce potentially inappropriate medication (PIM) use in hospitalized elderly adults.
Segmented regression analysis of an interrupted time series.
Teaching hospital.
Individuals aged 75 and older discharged from the hospital in 2013/14 (mean age 83.3, 54.5% female).
The KT strategy comprises the distribution of educational materials, presentations by geriatricians, pharmacist-physician interventions based on alerts from a computerized alert system, and comprehensive geriatric assessments.
Rate of PIM use (number of patient-days with use of at least one PIM/number of patient-days of hospitalization for individuals aged ≥75).
For 8,622 patients with 14,071 admissions, a total of 145,061 patient-days were analyzed. One or more PIMs were prescribed on 28,776 (19.8%) patient-days; a higher rate was found for individuals aged 75 to 84 (24.0%) than for those aged 85 and older (14.4%) (P < .001), and in women (20.8%) than in men (18.6%) (P < .001). The drug classes most frequently accounting for the PIM were gastrointestinal agents (21%), antihistamines (18%), and antidepressants (17%). An absolute decrease of 3.5% (P < .001) of patient-days with at least one PIM was observed immediately after the intervention.
A KT strategy resulted in decreased use of PIM in elderly adults in the hospital. Additional interventions will be implemented to maintain or further reduce PIM use.
评估知识转化（KT）策略对减少住院老年患者潜在不适当用药（PIM）的效果。
中断时间序列的分段回归分析。
教学医院。
2013/14年从该医院出院的75岁及以上个体（平均年龄83.3岁，女性占54.5%）。
KT策略包括分发教育材料、老年科医生进行讲座、基于计算机警报系统的警报由药剂师 - 医生进行干预以及全面的老年评估。
PIM使用率（使用至少一种PIM的患者天数/≥75岁个体的住院患者天数）。
对8622例患者的14071次入院进行分析，共145061个患者天数。在28776个（19.8%）患者天数中开具了一种或多种PIM；75至84岁个体的PIM使用率（24.0%）高于85岁及以上个体（14.4%）（P <.001），女性（20.8%）高于男性（18.6%）（P <.001）。导致PIM的最常见药物类别是胃肠道药物（21%）、抗组胺药（18%）和抗抑郁药（17%）。干预后立即观察到至少使用一种PIM的患者天数绝对减少了3.5%（P <.001）。
KT策略可减少医院老年患者的PIM使用。将实施额外干预措施以维持或进一步减少PIM使用。
