多方面干预对老年精神科患者的影响：一年期前瞻性研究。
Effects of a multifaceted intervention in psychogeriatric patients: one-year prospective study.
作者信息
Hernandez Marta, Mestres Concepción, Junyent Jaume, Costa-Tutusaus Lluís, Modamio Pilar, Fernandez Lastra Cecilia, Mariño Eduardo L
机构信息
Pharmacy Department, Grup Mutuam, Barcelona, Spain.
School of Health Sciences Blanquerna, University Ramon Llull, Barcelona, Spain.
出版信息
Eur J Hosp Pharm. 2020 Jul;27(4):226-231. doi: 10.1136/ejhpharm-2018-001647. Epub 2018 Nov 26.
OBJECTIVES
The aetiology of behavioural and psychological symptoms (BPSD) could be related to inadequate treatment in patients with dementia. The aim of this study was to determine how a multifaceted intervention based on a medication review and multidisciplinary follow-up could improve treatment and minimise risk in these patients.
METHODS
A prospective interventional study was undertaken between July 2015 and July 2016 of patients with dementia admitted to control BPSD. Patients with previous psychiatric illness or palliative care were excluded. Prescription information was obtained from Aegerus and the Catalonia clinical record HC3. The intervention was conducted by a multidisciplinary team. The Medication Appropriateness Index (MAI) was used to assess the intervention.
RESULTS
65 patients (60% women, mean age 84.9±6.7 years) with mild-moderate cognitive impairment (mean 4.5±1.8), moderate-severe functional dependence (mean 43.8±23.9) and a high prevalence of geriatric syndromes and comorbidity were included in the study. 87.7% of the patients were taking ≥5 drugs (mean 9.0±3.1) and 38.5% were taking ≥10. Patients presented with BPSD values of 1.9±0.8 at admission. Common symptoms prompting admission were agitation (47.7%) and irritability (43.1%). A total of 175 drug-related problems (DRPs) were detected (2.97 per patient). Significant differences (p<0.001) were found between the MAI score at admission (4±4.6) and post-intervention (0.5±2.6). Most prevalent MAI criteria were related to interactions (40%), dosage (38.5%) and duplication (26.2%). 55 patients (84.6%) were taking anticholinergic drugs at admission (2.6±1.2 anticholinergic drugs per patient), and the post-intervention reduction was significant (p<0.016).
CONCLUSIONS
The balance between effective treatment and safety is complex in these patients. Medication review in interdisciplinary teams is an essential component to optimise interventions and assessment of safety.
目的
行为和心理症状（BPSD）的病因可能与痴呆患者治疗不充分有关。本研究的目的是确定基于药物审查和多学科随访的多方面干预如何改善这些患者的治疗并将风险降至最低。
方法
2015年7月至2016年7月期间，对因控制BPSD入院的痴呆患者进行了一项前瞻性干预研究。排除既往有精神疾病或姑息治疗的患者。从Aegerus和加泰罗尼亚临床记录HC3中获取处方信息。干预由多学科团队进行。使用药物适宜性指数（MAI）评估干预效果。
结果
研究纳入了65例患者（60%为女性，平均年龄84.9±6.7岁），这些患者有轻度至中度认知障碍（平均4.5±1.8）、中度至重度功能依赖（平均43.8±23.9），且老年综合征和合并症的患病率较高。87.7%的患者服用≥5种药物（平均9.0±3.1种），38.5%的患者服用≥10种。患者入院时BPSD评分为1.9±0.8。促使入院的常见症状为躁动（47.7%）和易怒（43.1%）。共检测到175个药物相关问题（DRP）（每位患者2.97个）。入院时MAI评分（4±4.6）与干预后（0.5±2.6）之间存在显著差异（p<0.001）。最常见的MAI标准与相互作用（40%）、剂量（38.5%）和重复用药（26.2%）有关。55例患者（84.6%）入院时服用抗胆碱能药物（每位患者2.6±1.2种抗胆碱能药物），干预后减少显著（p<0.016）。
结论
在这些患者中，有效治疗与安全性之间的平衡很复杂。跨学科团队进行的药物审查是优化干预措施和安全性评估的重要组成部分。
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