Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada.
Research center on Aging - Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada.
Eur J Clin Pharmacol. 2019 Jul;75(7):1017-1023. doi: 10.1007/s00228-019-02660-x. Epub 2019 Mar 21.
Potentially inappropriate medications (PIMs) have been associated with a greater risk of adverse drug events and hospitalizations. To reduce PIMs use, a family health team (FHT) implemented a knowledge translation (KT) strategy that included a pharmacist-physician intervention model based on alerts from a computerized alert system (CAS).
Our pragmatic, single-site, pilot study was conducted in an FHT clinic in Quebec, Canada. We included community-dwelling older adults (≥ 65 years), with at least 1 alert for selected PIMs and a medical appointment during the study period. PIMs were selected from the Beers and STOPP criteria. The primary outcome was PIMs cessation, decreased dose, or replacement. The secondary outcome was the clinical relevance of the alerts as assessed by the pharmacists.
During the 134 days of the study, the CAS screened 369 individuals leading to the identification of 65 (18%) patients with at least 1 new alert. For those 65 patients, the mean age was 77 years, men accounted for 29% of the group and 55% were prescribed 10 or more drugs. One or more clinically relevant alerts were generated for 27 of 65 included patients for an overall clinical relevance of the alerts of 42%. Of the 27 patients with at least 1 relevant alert, 17 (63%) had at least 1 medication change as suggested by the pharmacist.
An interdisciplinary pharmacist-physician intervention model, based on alerts generated by a CAS, reduced the use of PIMs in community-dwelling older adults followed by an FHT.
不适当药物（PIMs）与药物不良事件和住院风险增加有关。为了减少 PIMs 的使用，家庭健康团队（FHT）实施了一项知识转化（KT）策略，该策略包括基于计算机警报系统（CAS）警报的药剂师-医师干预模式。
我们在加拿大魁北克的一个 FHT 诊所进行了这项实用、单站点、试点研究。我们纳入了居住在社区中的老年人（≥65 岁），在研究期间至少有 1 次针对选定 PIMs 的警报和 1 次医疗预约。PIMs 选自 Beers 和 STOPP 标准。主要结局是 PIMs 的停药、减少剂量或更换。次要结局是药剂师评估的警报的临床相关性。
在研究的 134 天中，CAS 筛查了 369 人，确定了 65 人（18%）至少有 1 次新警报。对于这 65 名患者，平均年龄为 77 岁，男性占 29%，55%的患者服用了 10 种或更多药物。对于纳入的 65 名患者中的 27 名患者，生成了 1 个或多个临床相关警报，警报的总体临床相关性为 42%。在至少有 1 个相关警报的 27 名患者中，17 名（63%）患者根据药剂师的建议至少有 1 种药物发生了变化。
基于 CAS 生成的警报，采用药剂师-医师的干预模式，可以减少 FHT 中居住在社区中的老年人使用 PIMs。
