药剂师主导的德国长期护理机构老年居民药物治疗审查。
Pharmacist-led medication reviews for geriatric residents in German long-term care facilities.
机构信息
Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany.
AOK Rheinland/Hamburg Health Insurance, Kasernenstr. 61, 40213, Düsseldorf, Germany.
出版信息
BMC Geriatr. 2019 Feb 11;19(1):39. doi: 10.1186/s12877-019-1052-z.
BACKGROUND
The benefit of medication reviews for long-term care (LTC) residents has been generally recognized throughout health care systems. Whereas many studies showed the impact of comprehensive medication reviews performed by specialized clinical pharmacists, little is known about the impact of medication reviews performed by community pharmacists. Involving them in the provision of medication reviews may help satisfy the increasing demand for ensuring medication safety.
METHODS
Community pharmacists supplying drugs to the LTC facilities performed a medication review for German LTC residents aged at least 65 years and taking five or more drugs per day based on the patients' medication only. Documented potential drug-related problems (DRPs) and the implementation rate of pharmaceutical interventions were evaluated descriptively. To assess the quality of the medication reviews, we developed a corresponding reference system based on the analysis of two experienced clinical pharmacists.
RESULTS
Twelve pharmacies performed medication reviews for 94 LTC residents. Overall, the pharmacists documented 154 potential DRPs (mean 1.6 per patient, SD 1.5) of which the most common were drug-drug interactions (40%) followed by potentially inappropriate medication (PIM) (16%) and inappropriate dosages (14%). 33% of the pharmacists' interventions to solve DRPs were successfully implemented, mostly dosage adjustments. The identification of potentially severe drug-drug interactions and PIM showed the highest agreement (88 and 73%) with the reference system.
CONCLUSIONS
The medication review program of community pharmacists for LTC residents led to the identification of relevant DRPs. The reference system assessing the quality of the service can contribute to its transparency and reveals the potential for its improvement. The community pharmacists' knowledge of the LTC residents and their relation to the prescribers is crucial for providing successful medication reviews.
背景
长期护理（LTC）居民用药审查的益处已在整个医疗保健系统中得到普遍认可。虽然许多研究表明，由专业临床药师进行全面药物审查的影响，但对于社区药师进行药物审查的影响知之甚少。让他们参与提供药物审查可能有助于满足确保药物安全的需求不断增加。
方法
为德国 LTC 设施提供药物的社区药剂师仅根据患者的药物为至少 65 岁且每天服用五种或更多药物的 LTC 居民进行药物审查。描述性评估记录的潜在药物相关问题（DRP）和药物干预实施率。为了评估药物审查的质量，我们根据两名经验丰富的临床药师的分析，制定了相应的参考系统。
结果
12 家药店为 94 名 LTC 居民进行了药物审查。总体而言，药剂师记录了 154 个潜在的 DRP（平均每个患者 1.6 个，SD 1.5），其中最常见的是药物相互作用（40%），其次是潜在不适当药物（PIM）（16%）和不适当剂量（14%）。药剂师解决 DRP 的干预措施中有 33%得到了成功实施，主要是剂量调整。识别潜在严重的药物相互作用和 PIM 与参考系统的一致性最高（88%和 73%）。
结论
社区药师为 LTC 居民进行的药物审查计划导致发现了相关的 DRP。评估服务质量的参考系统有助于提高其透明度，并显示出改进的潜力。社区药剂师对 LTC 居民的了解及其与开处方者的关系对于提供成功的药物审查至关重要。
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