Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada; Quebec Centre of Excellence on Aging, Quebec, Canada.
Department of Family Medicine, University of Sherbrooke, Canada; Department of Medical and Surgical Sciences, University of Bologna, Italy.
Res Social Adm Pharm. 2019 Jun;15(6):761-766. doi: 10.1016/j.sapharm.2018.09.008. Epub 2018 Sep 19.
Clinical practice guidelines are useful to suggest pharmacological therapies for the treatment of single chronic diseases. However, there is little guidance for multimorbidity, and specific quality measures for people with multimorbidity that can be used at a population level are lacking.
To describe what pharmacists and geriatricians consider to be an optimal basic pharmacological therapy for an older individual with type 2 diabetes (DM), chronic obstructive pulmonary disease (COPD) and heart failure (HF).
An online cross-sectional survey among 162 pharmacists and geriatricians, in Quebec, Canada, was performed. Participants were invited to choose, from a list of 32 medications or classes, the optimal basic therapy for an individual aged 65-75 years with the 3 chronic diseases. Descriptive statistics were used to calculate the median number of medications chosen and the proportions of participants who chose each medication, according to the participant's specialty. A Kruskall-Wallis test was performed to detect whether there were differences in the median number of medications recommended according to speciality.
There was little consensus on the optimal basic pharmacological therapy for this hypothetical multimorbid individual, with 157 different combinations provided by the 162 participants. Nevertheless, 5 classes were chosen by at least 75% of the participants: metformin, long-acting anticholinergic agents, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), beta-blockers, and short-acting beta-agonists. The median number of recommended medications was 10 (interquartile range [IQR]: 6-13). There was a statistically significant difference between specialties (p = 0.0396). Geriatricians recommended the lower median number of medications, 7 (IQR: 5-10).
At least half of the participants considered polypharmacy (≥10 medications) inevitable for an optimal basic treatment of DM, COPD and HF. The heterogeneity of responses raises issues when considering quality indicators in population-based studies.
临床实践指南有助于为单一慢性疾病的治疗提供药物治疗建议。然而，针对多种疾病的指导很少，并且缺乏可在人群层面使用的针对多种疾病人群的特定质量指标。
描述药剂师和老年病学家认为 2 型糖尿病（DM）、慢性阻塞性肺疾病（COPD）和心力衰竭（HF）老年患者的基本优化药物治疗方案。
在加拿大魁北克省进行了一项针对 162 名药剂师和老年病学家的在线横断面调查。邀请参与者从 32 种药物或类别中为一名年龄在 65-75 岁、患有 3 种慢性疾病的个体选择基本优化治疗方案。使用描述性统计计算根据参与者的专业选择的药物数量的中位数和每个药物的参与者比例。使用 Kruskal-Wallis 检验检测根据专业推荐的药物数量中位数是否存在差异。
对于这种假设的多种疾病患者，基本药物治疗方案的选择几乎没有共识，162 名参与者提供了 157 种不同的组合。然而，至少有 75%的参与者选择了 5 种药物类别：二甲双胍、长效抗胆碱能药物、血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）、β受体阻滞剂和短效β-激动剂。推荐药物的中位数为 10（四分位距[IQR]：6-13）。专业之间存在统计学差异（p=0.0396）。老年病学家推荐的药物中位数较少，为 7（IQR：5-10）。
至少一半的参与者认为，对于 DM、COPD 和 HF 的最佳基本治疗，多药治疗（≥10 种药物）是不可避免的。回应的异质性在考虑基于人群的研究中的质量指标时引发了问题。
