Willeboordse Floor, Schellevis François G, Chau Sek Hung, Hugtenburg Jacqueline G, Elders Petra J M
Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
Fam Pract. 2017 Aug 1;34(4):437-445. doi: 10.1093/fampra/cmx007.
Inappropriate drug use is a frequent problem in older patients and associated with adverse clinical outcomes and an important determinant of geriatric problems. Clinical medication reviews (CMR) may reduce inappropriate drug use.
The aim of this study is to investigate the effectiveness of CMR on quality of life (QoL) and geriatric problems in comparison with usual care in older patients with geriatric problems in the general practice.
We performed a cluster randomised controlled trial in 22 Dutch general practices. Patients of ≥65 years were eligible if they newly presented with pre-specified geriatric symptoms in general practice and the chronic use of ≥1 prescribed drug. The intervention consisted of CMRs which were prepared by an independent expert team and discussed with the patient by the general practitioner. Primary outcomes: QoL and the presence of self-reported geriatric problems after a follow-up period of 6 months.
518 patients were included. No significant differences between the intervention and control group and over time were found for QoL, geriatric problems, satisfaction with medication and self-reported medication adherence. After 6 months the percentage of solved Drug Related Problems (DRPs) was significantly higher in the intervention group compared to the control group [B 22.6 (95%CI 14.1-31.1), P < 0.001].
The study intervention did not influence QoL and geriatric problems. The higher percentage of solved DRPs in the intervention group did not result in effects on the patient's health. CMRs on a large scale seem not meaningful and should be reconsidered.
不适当用药在老年患者中是一个常见问题，与不良临床结局相关，并且是老年问题的一个重要决定因素。临床用药评估（CMR）可能会减少不适当用药。
本研究的目的是在全科医疗中，将CMR与常规护理相比较，调查其对老年问题患者生活质量（QoL）和老年问题的有效性。
我们在22家荷兰全科诊所进行了一项整群随机对照试验。年龄≥65岁、在全科医疗中新出现预先指定的老年症状且长期使用≥1种处方药的患者符合入选条件。干预措施包括由一个独立专家团队编写并由全科医生与患者讨论的CMR。主要结局：6个月随访期后的生活质量和自我报告的老年问题的存在情况。
纳入了518名患者。在生活质量、老年问题、对药物治疗的满意度和自我报告的药物治疗依从性方面，干预组和对照组之间以及随时间推移均未发现显著差异。6个月后，与对照组相比，干预组解决的药物相关问题（DRP）百分比显著更高[B 22.6（95%CI 14.1 - 31.1），P < 0.001]。
本研究干预措施未影响生活质量和老年问题。干预组中解决的DRP百分比更高，但并未对患者健康产生影响。大规模的CMR似乎没有意义，应重新考虑。
