一种结构化的药物评估工具，用于促进成年智障人士的精神药物优化：可行性研究。

A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study.

机构信息

Division of Psychiatry, University College London, London, UK

Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, London, UK.

出版信息

BMJ Open. 2019 Dec 15;9(12):e033827. doi: 10.1136/bmjopen-2019-033827.

DOI:10.1136/bmjopen-2019-033827

PMID:31843854

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6924735/

Abstract

OBJECTIVES

To investigate the feasibility of delivering structured psychotropic medication review in community services for adults with intellectual disability (ID).

DESIGN

Single-arm feasibility study conducted over a 6-month period.

SETTING

Specialist community ID teams in England.

PARTICIPANTS

Psychiatrists working with adults with ID and adults with ID who had been prescribed psychotropic medication.

INTERVENTION

A structured web-based psychotropic medication review tool (the HealthTracker-based structured medication review) comprising measures of therapeutic benefit and adverse side-effects was made available for use by psychiatrists in routine clinic appointments. A summary measure of medication effectiveness was graphically presented to aid discussion and decision-making.

MAIN OUTCOME MEASURES

Feasibility metrics including number of people with ID referred, eligible and recruited, and uptake of the medication review tool in naturalistic clinical settings. Psychiatrist and patient feedback was collected to assess acceptability of the intervention and suggestions for development.

RESULTS

Fifteen psychiatrists from five clinical teams took part. In total 94 potentially eligible people with ID were referred, of whom 79 (84%) were recruited and together underwent 97 medication reviews over the 6-month study period. Feedback from participants with ID was favourable. Psychiatrists indicated that the HealthTracker-based structured medication review was broadly acceptable and suggested adaptations to improve integration with existing information technology systems and to enhance patient involvement in the review.

CONCLUSIONS

Structured psychotropic medication review can be used in community services for adults with ID as part of a programme of medication optimisation. It would be feasible to test clinical and patient outcomes of the HealthTracker-based medication review in a randomised clinical trial.

摘要

目的

调查在社区服务中为智力障碍（ID）成人提供结构化精神药物审查的可行性。

设计

为期 6 个月的单臂可行性研究。

设置

英格兰的专业社区 ID 团队。

参与者

与 ID 成人和已开处精神药物的 ID 成人一起工作的精神科医生。

干预措施

一个基于网络的结构化精神药物审查工具（基于 HealthTracker 的结构化药物审查），包括治疗益处和不良反应的措施，可供精神科医生在常规诊所预约中使用。药物有效性的综合衡量标准以图形方式呈现，以帮助讨论和决策。

主要结果衡量标准

可行性指标，包括 ID 患者的转诊人数、符合条件的人数和招募人数，以及在自然临床环境中药物审查工具的使用率。收集精神科医生和患者的反馈意见，以评估干预措施的可接受性，并提出改进建议。

结果

来自五个临床团队的 15 名精神科医生参加了研究。共有 94 名潜在符合条件的 ID 患者被转诊，其中 79 名（84%）被招募，并在 6 个月的研究期间共进行了 97 次药物审查。来自 ID 患者的反馈是积极的。精神科医生表示，基于 HealthTracker 的结构化药物审查是广泛可接受的，并建议进行一些调整，以改善与现有信息技术系统的整合，并增强患者在审查中的参与度。