Hahn M, Roll S C, Klein J
Vitos Klinik Eichberg, Kloster-Eberbach-Str.4, 65346, Eltville, Deutschland.
Pharmakologie für Naturwissenschaftler, FB 14, Goethe-Universität Frankfurt, Max-von-Laue Str. 9, 60438, Frankfurt, Deutschland.
Nervenarzt. 2018 Jul;89(7):796-800. doi: 10.1007/s00115-017-0412-1.
We evaluated the qualitative and quantitative changes of medications during the stay on a geriatric-psychiatric ward where the medication was optimized by a clinical pharmacist, and after discharge. The goal of the study was to analyze the continuity of the medication at the transfer from hospital to ambulatory care.
We interviewed 41 patients on the phone about their drug regimen 4 and 12 weeks after discharge. Medications were compared to their discharge medication. The number of medications from the PRISCUS list of inappropriate medications for the elderly as well as the number of drug interactions was documented. The drug interaction database MediQ was used to identify and classify the drug-drug interactions.
During the hospitalization of the patients, 101 interventions of the clinical pharmacist were recommended and accepted. In cooperation with the physicians, the number of drug interactions decreased by 44% and the number of PRISCUS list medications by 42%. Only 4 weeks after discharge, 54 drugs for 27 patients (66%) had already been changed. During the following 8 weeks, another 44 medications were changed in 14 patients (35%). The total number of drugs after discharge did not change. The number of moderate drug interactions (p = 0.17) of medications from the PRISCUS list increased (p = 0.77), but not significantly.
While the interventions of a clinical pharmacist can lead to a reduction in drug interactions and inappropriate medication for the elderly during the hospitalization, the medication was changed after discharge in numerous cases. In a detailed analysis it was found that some of the changes increased the number of drug interactions as well as the number of potentially inappropriate medications for the elderly. A drug interaction check after discharge could prevent drug interactions and medication errors. Also the nationwide medication plan can help to prevent medication errors by the prescribing physician as well as by the patient.
我们评估了在老年精神科病房住院期间（期间临床药师对用药进行了优化）及出院后药物的定性和定量变化。本研究的目的是分析从医院转至门诊护理时用药的连续性。
我们在患者出院后4周和12周通过电话采访了41名患者，了解他们的用药方案。将用药情况与出院时的用药进行比较。记录了老年人PRISCUS不适当用药清单中的用药数量以及药物相互作用的数量。使用药物相互作用数据库MediQ来识别和分类药物相互作用。
在患者住院期间，临床药师提出并被采纳了101项干预措施。与医生合作后，药物相互作用的数量减少了44%，PRISCUS清单上的用药数量减少了42%。出院仅4周后，27名患者（66%）的54种药物就已发生变化。在接下来的8周内，又有14名患者（35%）的44种药物发生了变化。出院后药物总数未变。PRISCUS清单上药物的中度药物相互作用数量增加（p = 0.77），但无显著差异（p = 0.17）。
虽然临床药师的干预可在住院期间减少老年人的药物相互作用和不适当用药，但出院后仍有许多病例发生了用药变化。详细分析发现，其中一些变化增加了药物相互作用的数量以及老年人潜在不适当用药的数量。出院后的药物相互作用检查可预防药物相互作用和用药错误。此外，全国性用药计划有助于预防开方医生和患者的用药错误。
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