Sinnemäki Juha, Airaksinen Marja, Valaste Maria, Saastamoinen Leena K
a Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy , University of Helsinki , Helsinki , Finland.
b Research Department , The Social Insurance Institution , Helsinki , Finland.
Scand J Prim Health Care. 2017 Dec;35(4):379-386. doi: 10.1080/02813432.2017.1398933. Epub 2017 Nov 10.
In an automated dose dispensing (ADD) service, medicines are dispensed in unit-dose bags according to administration times. When the service is initiated, the patient's medication list is reconciled and a prescription review is conducted. The service is expected to reduce drug use. The aim of this national controlled study was to investigate whether the ADD service with medication review reduces drug use among geriatric primary care patients.
DESIGN, SETTING AND PATIENTS: This is a nationwide cohort study with matched controls. The study group consisted of all primary care patients ≥65 years enrolled in the ADD service in Finland during 2007 (n = 2073). Control patients (n = 2073) were matched by gender, age, area of patient's residence and number of the prescription drugs reimbursed. The data on all prescription drugs reimbursed during the 1 year periods before and after the ADD service enrollment were extracted from the Finnish National Prescription Register. Drug use was calculated as defined daily doses (DDD) per day.
The studied 20 most used drugs covered 86% of all reimbursed drug use (in DDD) of the study group. The use of 11 out of these 20 active substances studied was reduced significantly (p < .001-.041) when the drug use was adjusted by the number of chronic diseases. Two of these drugs were hypnotics and six were cardiovascular system drugs.
Drug use was decreased after initiation of the ADD service in primary care patients ≥65 years compared to matched controls in this 1 year cohort study. Further studies should be conducted in order to explore the causality, assess the ADD service's impact on drug use quality and costs, as well as impact of accompanied prescription review on positive outcomes.
在自动剂量调配（ADD）服务中，药物会根据给药时间分装在单位剂量袋中。启动该服务时，会核对患者的用药清单并进行处方审核。预期该服务能减少药物使用。这项全国性对照研究的目的是调查进行药物审核的ADD服务是否能减少老年初级护理患者的药物使用。
设计、研究地点与患者：这是一项有匹配对照组的全国性队列研究。研究组由2007年在芬兰登记加入ADD服务的所有65岁及以上初级护理患者组成（n = 2073）。对照患者（n = 2073）按性别、年龄、患者居住地区和报销处方药数量进行匹配。从芬兰国家处方登记处提取了加入ADD服务前后1年期间所有报销处方药的数据。药物使用以每日限定日剂量（DDD）计算。
研究组中使用频率最高的20种药物占所有报销药物使用量（以DDD计）的86%。在根据慢性病数量调整药物使用量后，所研究的这20种活性物质中有11种的使用量显著减少（p < 0.001 - 0.041）。其中两种药物为催眠药，六种为心血管系统药物。
在这项为期1年的队列研究中，与匹配的对照组相比，65岁及以上初级护理患者启动ADD服务后药物使用量有所减少。应进一步开展研究，以探究因果关系，评估ADD服务对药物使用质量和成本的影响，以及伴随的处方审核对积极结果的影响。
