Najjar Muath Fahmi, Sulaiman Syed Azhar Syed, Al Jeraisy Majed, Balubaid Hashim
King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Science, College of Pharmacy, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
Pharmaceutical Sciences School, Clinical Pharmacy Discipline, Universiti Sains Malaysia, Penang, Malaysia.
Ther Clin Risk Manag. 2018 Mar 16;14:557-564. doi: 10.2147/TCRM.S157469. eCollection 2018.
There is a difference between evidence-based guidelines for geriatric patients and clinical practice of physicians. Prescribing potentially inappropriate medications (PIMs) can be attributed to the fact that many physicians are not aware of PIMs usage.
The aim of this study was to assess the effectiveness of a combined intervention program comprising an educational and clinical pharmacist intervention to reduce the incidence of PIMs among hospitalized geriatric patients.
This was a prospective pre-test versus post-test design study. The screening tool of older persons' prescriptions, 2nd version, and 2015 American Geriatric Society Beers' criteria were used to assess the appropriateness of medications prescribed for geriatric inpatients. The study was carried out in the medical wards of the Department of Medicine at King Abdulaziz Medical City in Riyadh, Saudi Arabia.
Four hundred geriatric patients were enrolled in the study: 200 in a pre-intervention group (control) and 200 in the intervention group. After the combined intervention, the incidence rate of PIMs decreased significantly from 61% to 29.5% (<0.001). Out of 317 recommendations given by the clinical pharmacist, the physicians accepted a total of 196 (61.83%) recommendations. The most common PIMs to avoid regardless of diagnosis of geriatric patients before interventions were first-generation antihistamines (46%), sliding scale insulin (18.5%), antipsychotics (6.5%), benzodiazepines (9.5%), and antiarrhythmic drugs (15%).
Using a combined intervention program that comprises an educational intervention of updated evidence-based guidelines and clinical pharmacist intervention would add a significant value to improve prescribing patterns in hospitalized geriatric patients.
老年患者的循证指南与医生的临床实践之间存在差异。开具潜在不适当药物（PIMs）可能是因为许多医生并不了解PIMs的使用情况。
本研究旨在评估一项由教育干预和临床药师干预组成的联合干预项目在降低老年住院患者中PIMs发生率方面的效果。
这是一项前瞻性的前后测设计研究。使用老年人处方筛查工具第2版和2015年美国老年医学会Beers标准来评估老年住院患者所开药物的适宜性。该研究在沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城内科的病房中进行。
400名老年患者参与了本研究：200名在干预前组（对照组），200名在干预组。联合干预后，PIMs的发生率从61%显著降至29.5%（<0.001）。在临床药师给出的317条建议中，医生总共接受了196条（61.83%）建议。干预前无论老年患者诊断如何都应避免使用的最常见PIMs为第一代抗组胺药（46%）、滑动比例胰岛素（18.5%）、抗精神病药物（6.5%）、苯二氮䓬类药物（9.5%）和抗心律失常药物（15%）。
采用一项由更新的循证指南教育干预和临床药师干预组成的联合干预项目，对于改善老年住院患者的处方模式将具有显著价值。
