Department of Internal Medicine, Geriatric Medicine, Maastricht University Medical Centre, Maastricht University, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Int J Clin Pharm. 2019 Oct;41(5):1262-1271. doi: 10.1007/s11096-019-00879-3. Epub 2019 Jul 13.
Background Polypharmacy in older patients can lead to potentially inappropriate prescribing. The risk of the latter calls for effective medication review to ensure proper medication usage and safety. Objective Provide insight on the similarities and differences of medication review done in multiple ways that may lead to future possibilities to optimize medication review. Setting This study was conducted in Zuyderland Medical Centre, the second largest teaching hospital in the Netherlands. Method This descriptive study compares the quantity and content of remarks identified by medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System. The content of remarks is categorized in seven categories of possible pharmacotherapeutic problems: 'indication without medication', 'medication without indication', 'contra-indication/interaction/side-effect', 'dosage problem', 'double medication', 'incorrect medication' and 'therapeutic drug monitoring'. Main outcome measure Number and content of remarks on medication review. Results The Clinical Decision Support System (1.8 ± 0.8 vs. 0.9 ± 0.9, p < 0.001) and outpatient pharmacist (1.8 ± 0.8 vs. 0.9 ± 0.9, p = 0.045) both noted remarks in significantly more categories than the geriatricians. The Clinical Decision Support System provided more remarks on 'double medication', 'dosage problem' and 'contraindication/interaction/side effects' than the geriatrician (p < 0.050), while the geriatrician did on 'medication without indication' (p < 0.001). The Clinical Decision Support System noted significantly more remarks on 'contraindication/interaction/side effects' and 'therapeutic drug monitoring' than the outpatient pharmacist, whereas the outpatient pharmacist reported more on 'indication without medication' and 'medication without indication' than the Clinical Decision Support System (p ≤ 0.007). Conclusion Medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System provides different insights and should be combined to create a more comprehensive report on medication profiles.
老年患者的多种药物治疗可能导致潜在的不适当处方。后者的风险需要有效的药物审查，以确保药物的正确使用和安全。
提供关于通过多种方式进行药物审查的异同点的见解，这些方式可能为优化药物审查提供未来的可能性。
本研究在荷兰第二大教学医院 Zuyderland 医疗中心进行。
本描述性研究比较了老年病学家、门诊药剂师和临床决策支持系统进行的药物审查所发现的评论的数量和内容。评论的内容分为七个可能的药物治疗问题类别：“无药物适应证”、“无适应证用药”、“禁忌证/相互作用/副作用”、“剂量问题”、“双重用药”、“用药错误”和“治疗药物监测”。
药物审查评论的数量和内容。
临床决策支持系统（1.8±0.8 比 0.9±0.9，p<0.001）和门诊药剂师（1.8±0.8 比 0.9±0.9，p=0.045）在明显更多的类别中记录了评论，比老年病学家更多。临床决策支持系统比老年病学家更多地提供了关于“双重用药”、“剂量问题”和“禁忌证/相互作用/副作用”的评论（p<0.050），而老年病学家则更多地提供了关于“无适应证用药”的评论（p<0.001）。临床决策支持系统比门诊药剂师更多地记录了关于“禁忌证/相互作用/副作用”和“治疗药物监测”的评论，而门诊药剂师比临床决策支持系统更多地报告了关于“无适应证用药”和“无适应证用药”的评论（p≤0.007）。
老年病学家、门诊药剂师和临床决策支持系统进行的药物审查提供了不同的见解，应结合起来，以创建更全面的药物概况报告。
