Bech Christine Flagstad, Frederiksen Tine, Villesen Christine Tilsted, Højsted Jette, Nielsen Per Rotbøll, Kjeldsen Lene Juel, Nørgaard Lotte Stig, Christrup Lona Louring
Department of Drug Design and Pharmacology, University of Copenhagen, 2 Universitetsparken, Copenhagen, Denmark.
Multidisciplinary Pain Centre, Copenhagen University Hospital, 9. Blegdamsvej, Copenhagen, Denmark.
Int J Clin Pharm. 2018 Feb;40(1):119-125. doi: 10.1007/s11096-017-0572-x. Epub 2017 Dec 16.
Background Disagreement among healthcare professionals on the clinical relevance of drug-related problems can lead to suboptimal treatment and increased healthcare costs. Elderly patients with chronic non-cancer pain and comorbidity are at increased risk of drug related problems compared to other patient groups due to complex medication regimes and transition of care. Objective To investigate the agreement among healthcare professionals on their classification of clinical relevance of drug-related problems in elderly patients with chronic non-cancer pain and comorbidity. Setting Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen, Denmark. Method A pharmacist performed medication review on elderly patients with chronic non-cancer pain and comorbidity, identified their drug-related problems and classified these problems in accordance with an existing categorization system. A five-member clinical panel rated the drug-related problems' clinical relevance in accordance with a five-level rating scale, and their agreement was compared using Fleiss' κ. Main outcome measure Healthcare professionals' agreement on clinical relevance of drug related problems, using Fleiss' κ. Results Thirty patients were included in the study. A total of 162 drug related problems were identified, out of which 54% were of lower clinical relevance (level 0-2) and 46% of higher clinical relevance (level 3-4). Only slight agreement (κ = 0.12) was found between the panellists' classifications of clinical relevance using a five-level rating scale. Conclusion The clinical pharmacist identified drug related problems of lower and higher clinical relevance. Poor overall agreement on the severity of the drug related problems was found among the panelists.
背景 医疗保健专业人员在药物相关问题的临床相关性上存在分歧，可能导致治疗效果欠佳并增加医疗成本。与其他患者群体相比，患有慢性非癌性疼痛和合并症的老年患者由于用药方案复杂和护理过渡，出现药物相关问题的风险更高。目的 调查医疗保健专业人员在对患有慢性非癌性疼痛和合并症的老年患者药物相关问题的临床相关性分类上的一致性。地点 丹麦哥本哈根里格霍斯医院多学科疼痛中心。方法 一名药剂师对患有慢性非癌性疼痛和合并症的老年患者进行用药审查，识别他们的药物相关问题，并根据现有的分类系统对这些问题进行分类。一个由五名成员组成的临床小组根据五级评定量表对药物相关问题的临床相关性进行评级，并使用Fleiss' κ比较他们的一致性。主要结局指标 使用Fleiss' κ衡量医疗保健专业人员在药物相关问题临床相关性上的一致性。结果 30名患者纳入研究。共识别出162个药物相关问题，其中54%临床相关性较低（0 - 2级），46%临床相关性较高（3 - 4级）。在使用五级评定量表对临床相关性进行分类时，小组成员之间仅发现轻微一致性（κ = 0.12）。结论 临床药剂师识别出了临床相关性较低和较高的药物相关问题。小组成员之间在药物相关问题严重程度上的总体一致性较差。
