HIV Medical Affairs, Gilead Sciences, Inc., Foster City, California.
Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California.
Pharmacotherapy. 2017 Dec;37(12):1498-1506. doi: 10.1002/phar.2043. Epub 2017 Nov 30.
The goal of this pharmacist-led study was to utilize two validated instruments, Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP), to assess potentially inappropriate prescribing (PIP) in older patients infected with the human immunodeficiency virus (HIV) and evaluate pharmacist interventions.
Prospective randomized interventional trial.
Large urban clinic providing interdisciplinary primary and HIV care for ~2700 HIV-positive publicly insured patients.
A computerized electronic record search was conducted for all patients who met the two search criteria: 50 years and older, and a primary care appointment within the last 12 months.
After identification of 857 patients meeting the search criteria, 324 patients were randomly selected and contacted, resulting in 248 patients assessed.
Patients had a mean age of 58 years, 71% male, 44% white, and a mean CD4 count of 536 cells/mm . Common comorbidities included hypertension (56%), depression (52%), asthma/chronic obstructive pulmonary disease (48%), dyslipidemia (39%), coronary artery disease (27%), and diabetes (22%). Patients sampled were prescribed a mean of 11.6 ± 5.7 concomitant medications (excluding antiretrovirals) with 35% receiving at least 16 medications. PIP was identified in 54% and 63% of patients using the STOPP and Beers Criteria, respectively. Twenty-five contraindicated drug interactions were identified in 20 patients. After the pharmacist visit, at least 69% of patients had at least one medication discontinued with almost 10% having six or more medications discontinued. More than 40% of patients had at least one Beers or STOPP criteria that required immediate correction by the pharmacist.
Results suggest that targeting individuals with 11 or more chronic medications would have the highest yield and greatest impact. Pharmacist-led review of medication prescribing using Beers and STOPP criteria revealed a large number of PIP, many amenable to immediate clinical pharmacist intervention.
这项由药剂师主导的研究旨在使用两种经过验证的工具，即 Beers 标准和老年人潜在不适当处方筛选工具（STOPP），评估感染人类免疫缺陷病毒（HIV）的老年患者中潜在不适当的处方（PIP）情况，并评估药剂师的干预措施。
前瞻性随机干预试验。
为大约 2700 名接受公共保险的 HIV 阳性患者提供跨学科初级和 HIV 护理的大型城市诊所。
对符合以下两个搜索标准的所有患者进行了计算机化电子记录搜索：50 岁及以上，且在过去 12 个月内有初级保健预约。
在确定符合搜索标准的 857 名患者后，随机选择并联系了 324 名患者，最终评估了 248 名患者。
患者的平均年龄为 58 岁，71%为男性，44%为白人，平均 CD4 计数为 536 个细胞/mm³。常见合并症包括高血压（56%）、抑郁（52%）、哮喘/慢性阻塞性肺疾病（48%）、血脂异常（39%）、冠状动脉疾病（27%）和糖尿病（22%）。抽样患者服用的平均药物为 11.6±5.7 种（不包括抗逆转录病毒药物），其中 35%的患者服用至少 16 种药物。分别使用 STOPP 和 Beers 标准，有 54%和 63%的患者存在潜在不适当的处方。在 20 名患者中发现了 25 种禁忌药物相互作用。在药剂师就诊后，至少有 69%的患者停止了至少一种药物，近 10%的患者停止了六种或更多药物。超过 40%的患者至少有一项需要药剂师立即纠正的 Beers 或 STOPP 标准。
结果表明，针对服用 11 种或更多慢性病药物的个体可能会产生最高的效果和最大的影响。使用 Beers 和 STOPP 标准进行的药剂师主导的药物处方审查发现，大量潜在不适当的处方存在，其中许多可立即由临床药剂师干预。
