Health Science Department, Public University of Navarra, Pamplona, Spain.
Geriatrics Research Group, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
Geriatr Gerontol Int. 2019 Jun;19(6):530-536. doi: 10.1111/ggi.13659. Epub 2019 Apr 5.
Older patients admitted to acute geriatric units (AGU) frequently use many medications and are particularly vulnerable to adverse drug events, so specific interventions in this setting are required. In the present study, we describe a new medicine optimization strategy in an AGU, and explore its potential in reducing polypharmacy and improving medication appropriateness.
The present prospective study included patients aged ≥75 years who were admitted to an AGU in a tertiary hospital. An intervention based on a pharmacist clinical interview, medication history and a structured medication review within a comprehensive geriatric assessment was proposed. The differences regarding polypharmacy as the primary outcome (≥5 chronic drugs), hyperpolypharmacy (≥10), number of drugs, drug-related problems and Screening Tool of Older Person's Prescription/Screening Tool to Alert Doctors to Right Treatment criteria between admission and discharge were evaluated.
From October 2016 to April 2017, 234 patients were enrolled, aged 87.6 years (SD 4.6 years); 143 (61.1%) were women. The intervention resulted in a statistically significant improvement in polypharmacy (-10.2%, 95% CI -15.3, -5.2), hyperpolypharmacy (-16.6%, 95% CI -22.3 -11.0), number of medications (-1.4, 95% CI -1.8, -1.0), Screening Tool of Older Person's Prescription criteria (-19.2%, 95% CI -24.9, -13.6), Screening Tool to Alert Doctors to Right Treatment criteria (-6.8%, 95% CI -10.1, -3.5) and drug-related problems (-2.7, 95% CI -2.9, -2.4; P ≤ 0.001 for all).
A systematic pharmacist-led intervention at hospital admission to an AGU within a comprehensive geriatric assessment was associated to a decrease in polypharmacy, drug-related problems and potentially inappropriate prescribing. Geriatr Gerontol Int 2019; 19: 530-536.
入住急性老年病房（AGU）的老年患者常使用多种药物，且特别容易发生药物不良事件，因此需要在该环境中采取特定的干预措施。本研究描述了 AGU 中一种新的药物优化策略，并探讨了其减少多种用药和提高药物适宜性的潜力。
本前瞻性研究纳入了一家三级医院 AGU 收治的年龄≥75 岁的患者。提出了一种基于药剂师临床访谈、用药史和综合老年评估中结构化药物审查的干预措施。评估了入院和出院时主要结局（≥5 种慢性药物）、高度多种用药（≥10 种）、药物种类、药物相关问题和老年人用药筛查工具/恰当治疗筛选工具的差异。
2016 年 10 月至 2017 年 4 月，共纳入 234 例患者，年龄 87.6 岁（标准差 4.6 岁）；143 例（61.1%）为女性。干预后，多种用药（-10.2%，95%置信区间-15.3，-5.2）、高度多种用药（-16.6%，95%置信区间-22.3，-11.0）、用药种类（-1.4，95%置信区间-1.8，-1.0）、老年人用药筛查工具（-19.2%，95%置信区间-24.9，-13.6）、恰当治疗筛选工具（-6.8%，95%置信区间-10.1，-3.5）和药物相关问题（-2.7，95%置信区间-2.9，-2.4）均有统计学显著改善（P 均≤0.001）。
在综合老年评估中，AGU 入院时由药剂师主导的系统干预与减少多种用药、药物相关问题和潜在不适当处方有关。
