Gauci Marise, Wirth Francesca, Camilleri Liberato, Azzopardi Lilian M, Serracino-Inglott Anthony
Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
Department of Pharmacy, Rehabilitation Hospital Karin Grech, Pieta, Malta.
Int J Clin Pharm. 2017 Oct;39(5):1008-1012. doi: 10.1007/s11096-017-0515-6. Epub 2017 Jul 29.
Background Optimisation of drug therapy is essential in the care of older persons and may be facilitated by application of medication assessment tools (MATs). Objective To design, psychometrically evaluate and apply an innovative MAT for secondary prevention of ischaemic stroke with particular relevance to older persons. Method Review criteria were selected from clinical practice guidelines and MAT-CVA was developed, validated and tested for reliability and feasibility. MAT-CVA was applied to 150 patients with a diagnosis of ischaemic stroke or transient ischaemic attack admitted to a rehabilitation hospital. Results MAT-CVA consists of 17 criteria sectioned into antithrombotic, lipid lowering, antihypertensive and glycaemic therapy. Content validity was demonstrated for all criteria. Reliability was confirmed with kappa values of 0.80 for both inter- and intraobserver agreements. Mean application time for the two observers was 5.55 and 6.56 min. Adherence to applicable criteria was 55% and justified non-adherence was 22.3%. Non-adherence was predominantly evident for prescription of anticoagulation in concurrent atrial fibrillation (36.4%), thiazide diuretics ± angiotensin converting enzyme inhibitors for hypertension (26.8%) and dipyridamole at the recommended dose (24.0%). Conclusion Application of MAT-CVA indicated good overall adherence and identified gaps in clinical performance which may be targeted to enhance drug therapy optimisation.
药物治疗的优化对于老年人护理至关重要，应用药物评估工具（MATs）可能会有所帮助。目的：设计、进行心理测量评估并应用一种创新的MAT，用于缺血性中风的二级预防，尤其适用于老年人。方法：从临床实践指南中选择审查标准，并开发、验证和测试MAT-CVA的可靠性和可行性。MAT-CVA应用于一家康复医院收治的150例诊断为缺血性中风或短暂性脑缺血发作的患者。结果：MAT-CVA由17条标准组成，分为抗血栓形成、降脂、降压和降糖治疗。所有标准均证明具有内容效度。观察者间和观察者内一致性的kappa值均为0.80，证实了可靠性。两位观察者的平均应用时间分别为5.55分钟和6.56分钟。符合适用标准的比例为55%，合理不遵守的比例为22.3%。不遵守主要表现为并发房颤时抗凝治疗的处方（36.4%）、噻嗪类利尿剂±血管紧张素转换酶抑制剂治疗高血压（26.8%）以及推荐剂量的双嘧达莫（24.0%）。结论：MAT-CVA的应用表明总体依从性良好，并发现了临床操作中的差距，可针对这些差距加强药物治疗优化。
