Alosaimy Sara, Vaidya Alka, Day Kevin, Stern Gretchen
Department of Pharmacy Services, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Drugs Aging. 2019 Apr;36(4):371-378. doi: 10.1007/s40266-018-00634-9.
Older adults have a seven times greater risk than younger adults of being hospitalized due to an adverse drug event.
The objective of this study was to compare the number of potentially inappropriate medications (PIMs) on admission to the number of PIMs on discharge following pharmacist intervention.
This was a prospective, single-center pilot study performed at a tertiary medical center. Eighty-two adults aged 65 years or older on five or more medications who were admitted to the general medicine floor between December 2016 and May 2017 were included in the analysis. Pharmacists completed a review of prior admission medications and identified PIMs. Recommendations for PIMs were communicated to the medical team and documented in the patient's electronic medical record. PIMs were measured by the use of validated screening tools and an assessment of patient-specific parameters.
Fifty-two percent of our patients were taking at least one PIM. The average number of PIMs on admission was found to be 0.84 ± 1.12. Pharmacist intervention resulted in a statistically significant reduction to an average of 0.56 ± 0.91 PIMs (P < 0.01). The mean time to complete the medication therapy management (MTM) process was 49.39 ± 16.2 min per patient.
While pharmacist-driven MTM significantly reduced PIMs in our study, the implementation of this model in the inpatient setting faces several challenges.
老年人因药物不良事件住院的风险比年轻人高7倍。
本研究的目的是比较药师干预前后入院时潜在不适当用药（PIM）的数量与出院时PIM的数量。
这是一项在三级医疗中心进行的前瞻性单中心试点研究。分析纳入了2016年12月至2017年5月期间入住普通内科病房、年龄在65岁及以上且服用五种或更多药物的82名成年人。药师对入院前用药进行了审查并确定了PIM。将PIM的建议传达给医疗团队并记录在患者的电子病历中。通过使用经过验证的筛查工具和评估患者特定参数来衡量PIM。
52%的患者至少服用一种PIM。入院时PIM的平均数量为0.84±1.12。药师干预后，PIM平均数量在统计学上显著减少至0.56±0.91（P<0.01）。完成药物治疗管理（MTM）过程的平均时间为每位患者49.39±16.2分钟。
虽然在我们的研究中，药师主导的MTM显著减少了PIM，但在住院环境中实施该模式面临若干挑战。
