Huon Valley Health Centre, 85 Main Road, Huonville, TAS, 7050, Australia.
School of Medicine, University of Tasmania, Hobart, TAS, Australia.
Int J Clin Pharm. 2019 Dec;41(6):1483-1490. doi: 10.1007/s11096-019-00908-1. Epub 2019 Sep 28.
Background Adverse drug reactions are common in Australian general practice and can be a cause of, or contribute to, preventable hospital admissions. Developing practical tools to assist in identifying patients who are at high risk of serious adverse drug reactions is an important step in preventing these hospitalisations. Objective The aims of the study were to apply the Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (PADR-EC) Score to assess the risk of medication-related hospitalisation among patients aged ≥ 65 years attending a rural general practice, and to investigate general practitioners' acceptance of the PADR-EC Score. Setting The project was based in a multicentre rural general practice in southern Tasmania, Australia. Method We conducted a cross-sectional study wherein the PADR-EC score was administered to patients aged ≥ 65 years attending a general practice. A focus group of general practice doctors was conducted and thematic analysis of the transcript used to explore their views regarding the utility of the PADR-EC score. Main Outcome Measures Successful application of the PADR-EC Score and an evaluation of general practitioners' acceptance of the PADR-EC Score are the two outcome measures of the project. Results The PADR-EC score was applied by the practice pharmacist and reported to GPs for 428 patients aged ≥ 65 years, with 24.8% classified as high-risk. The focus group found the PADR-EC score helped raise awareness of the risk of adverse drug reactions in the general practice setting. Doctors demonstrated good understanding of the PADR-EC Score and there were no negative reactions to the delivery model used. No changes to prescribing were implemented directly as a result of the PADR-EC Score, but more caution was used when doctors provided their usual clinical care. Conclusion Doctors used the PADR-EC score to complement their decision making. The PADR-EC Score was used as a reminder to review existing medication lists, follow-up on pathology results that may impact drug treatment and assess patients for prevalent ADRs. Further research is needed to validate the PADR-EC score in this setting.
背景
在澳大利亚的全科医疗中,药物不良反应很常见,可能是导致可预防住院的原因之一,或者促成可预防住院。开发实用工具来协助识别有发生严重药物不良反应高风险的患者,是预防这些住院的重要步骤。
目的
本研究旨在应用预测因药物不良反应而导致老年人住院的评分(PADR-EC 评分)来评估在塔斯马尼亚南部农村全科医疗就诊的≥65 岁患者发生药物相关住院的风险,并调查全科医生对 PADR-EC 评分的接受程度。
背景
该项目位于澳大利亚塔斯马尼亚南部的一个多中心农村全科医疗。
方法
我们进行了一项横断面研究,对在全科医疗就诊的≥65 岁患者进行 PADR-EC 评分。对一组全科医生进行了焦点小组讨论,并对转录本进行主题分析,以探讨他们对 PADR-EC 评分实用性的看法。
主要结果
本项目的两个结果测量指标为 PADR-EC 评分的成功应用和全科医生对 PADR-EC 评分的接受程度。
结果
该实践药剂师应用了 PADR-EC 评分,并向全科医生报告了 428 名≥65 岁患者的评分,其中 24.8%被归类为高风险。焦点小组发现,PADR-EC 评分有助于提高全科医疗环境中药物不良反应风险的认识。医生对 PADR-EC 评分有很好的理解,对所使用的传递模式也没有负面反应。并没有直接根据 PADR-EC 评分改变处方,但医生在提供常规临床护理时更加谨慎。
结论
医生使用 PADR-EC 评分来辅助决策。PADR-EC 评分被用作提醒,以审查现有的药物清单、跟进可能影响药物治疗的病理学结果,并评估患者是否存在普遍的不良反应。需要进一步的研究来验证 PADR-EC 评分在这种情况下的有效性。