Delgado-Silveira E, Albiñana-Pérez M S, Muñoz-García M, García-Mina Freire M, Fernandez-Villalba E M
Department of Pharmacy, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Department of Pharmacy, Complejo hospitalario Arquitecto Marcide, Ferrol, Spain.
Eur J Hosp Pharm. 2018 Jan;25(1):16-20. doi: 10.1136/ejhpharm-2016-001054. Epub 2016 Nov 23.
To compare potentially inappropriate prescribing (PIP) according to the clinical judgement of the pharmacist with PIP according to explicit STOPP-START criteria in institutionalised and hospitalised patients with multiple pathologies. To describe and compare the main pharmacological groups involved and determine the factors associated with the detection of PIP in these patients.
A prospective multicentre observational study of institutionalised and hospitalised multipathology patients aged >65 years. A specialised pharmacist used his best clinical judgement to detect PIP based on a comprehensive review of the complete chronic treatment of patients, which is an essential activity in interdisciplinary care. STOPP-START criteria were used as an aid tool to detect PIP. The main variable was the number of PIP incidents detected.
Detected PIP incidents were analysed in 338 patients. Clinical judgement detected more PIP incidents (35%) than did STOPP-START criteria. More PIP incidents unrelated to these criteria were detected in institutionalised patients than in hospitalised patients. Clinical judgement mainly detected PIP incidents related to incorrect doses and drug interactions (p<0.001); however, STOPP-START criteria mainly detected PIP incidents related to drug duplication and insufficiently treated diagnosis or symptoms (p=0.001 and p<0.001). In total, 93.8% of the PIP incidents were detected in polypharmacy patients (≥5 drugs). Institutionalised and high-level polypharmacy (≥10 drugs) patients were at the highest risk of PIP.
A large number of PIP incidents were detected in institutionalised and hospitalised patients with multiple pathologies. The inclusion of a pharmacist in the multidisciplinary team facilitated the detection of PIP incidents, particularly in the institutionalised population and patients treated with high-level polypharmacy which were not detected by explicit STOPP-START criteria.
比较根据药剂师的临床判断与根据明确的STOPP-START标准判断的潜在不适当处方（PIP），研究对象为患有多种病症的住院和机构化患者。描述并比较所涉及的主要药物类别，并确定与这些患者中PIP检测相关的因素。
对年龄大于65岁的住院和机构化的多病患者进行一项前瞻性多中心观察性研究。一名专业药剂师基于对患者完整慢性治疗方案的全面审查，运用其最佳临床判断来检测PIP，这是跨学科护理中的一项重要活动。STOPP-START标准用作检测PIP的辅助工具。主要变量是检测到的PIP事件数量。
对338例患者检测到的PIP事件进行了分析。临床判断检测到的PIP事件（35%）比STOPP-START标准更多。在机构化患者中检测到的与这些标准无关的PIP事件比住院患者更多。临床判断主要检测到与剂量错误和药物相互作用相关的PIP事件（p<0.001）；然而，STOPP-START标准主要检测到与药物重复以及诊断或症状治疗不足相关的PIP事件（p=0.001和p<0.001）。总共有93.8%的PIP事件在使用多种药物（≥5种药物）的患者中被检测到。机构化和高剂量多种药物治疗（≥10种药物）的患者发生PIP的风险最高。
在患有多种病症的住院和机构化患者中检测到大量PIP事件。在多学科团队中纳入药剂师有助于检测PIP事件，特别是在机构化人群以及接受高剂量多种药物治疗且未被明确的STOPP-START标准检测到的患者中。
