van Summeren Jojanneke Jgt, Schuling Jan, Haaijer-Ruskamp Flora M, Denig Petra
Department of General Practice, University of Groningen, University Medical Center Groningen, the Netherlands.
Drug Utilisation Studies, University of Groningen, University Medical Center Groningen, the Netherlands.
Br J Gen Pract. 2017 Jul;67(660):e501-e506. doi: 10.3399/bjgp17X690485. Epub 2017 Mar 27.
Several methods have been developed to conduct and support medication reviews in older persons with multimorbidity. Assessing the patient's priorities for achieving specific health outcomes can guide the medication review process. Little is known about the impact of conducting such assessments.
This pilot study aimed to determine proposed and observed medication changes when using an outcome prioritisation tool (OPT) during a medication review in general practice.
Participants were older patients with multimorbidity (aged ≥69 years) with polypharmacy (five or more chronic medications) from the practices of 14 GPs.
Patients were asked to prioritise four universal health outcomes - remaining alive, maintaining independence, reducing pain, and reducing other symptoms - using an OPT. GPs used this prioritisation to review the medication and to propose and discuss medication changes with the patient. The outcomes included the proposed medication change as documented by the GP, and the observed medication change in the electronic health record at follow-up. Descriptive analyses were conducted to determine medication changes according to the prioritised health outcomes.
A total of 59 patients using 486 medications prioritised the four health outcomes. GPs proposed 34 changes of medication, mainly stopping, for 20 patients. At follow-up, 14 medication changes were observed for 10 patients. The stopping of medication (mostly preventive) was particularly observed in patients who prioritised 'reducing other symptoms' as most important.
Using an OPT leads mainly to the stopping of medication. Medication changes appeared to be easiest for patients who prioritised 'reducing other symptoms' as most important.
已经开发了几种方法来对患有多种疾病的老年人进行并支持药物审查。评估患者实现特定健康结果的优先事项可以指导药物审查过程。关于进行此类评估的影响知之甚少。
这项试点研究旨在确定在全科医疗的药物审查中使用结果优先排序工具（OPT）时建议的和观察到的药物变化。
参与者是来自14名全科医生诊所的患有多种疾病（年龄≥69岁）且使用多种药物（五种或更多种慢性药物）的老年患者。
要求患者使用OPT对四个普遍的健康结果进行优先排序，即维持生命、保持独立、减轻疼痛和减轻其他症状。全科医生利用这种优先排序来审查药物，并与患者提出并讨论药物变化。结果包括全科医生记录的建议药物变化，以及随访时电子健康记录中观察到的药物变化。进行描述性分析以确定根据优先排序的健康结果的药物变化。
共有59名使用486种药物的患者对这四个健康结果进行了优先排序。全科医生提出了34项药物变化建议，主要是让20名患者停药。在随访时，观察到10名患者有14项药物变化。在将“减轻其他症状”列为最重要的患者中尤其观察到停药情况（大多为预防性用药）。
使用OPT主要导致停药。对于将“减轻其他症状”列为最重要的患者，药物变化似乎最为容易。
