NHMRC Cognitive Decline Partnership Centre, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia.
Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Br J Clin Pharmacol. 2021 Mar;87(3):1499-1511. doi: 10.1111/bcp.14557. Epub 2020 Nov 2.
The Goal-directed Medication Review Electronic Decision Support System (G-MEDSS) assesses and reports a patient's goals, attitudes to deprescribing and Drug Burden Index (DBI) score, a measure of cumulative exposure to anticholinergic and sedative medications. This study evaluated the effect of implementing G-MEDSS in home medicines reviews (HMRs) on DBI exposure and clinical outcomes.
A cluster-randomised clinical trial was performed across Australia. Accredited clinical pharmacists were randomised into intervention (G-MEDSS with usual care HMR) or comparison groups (usual care HMR alone). Patients were recruited by pharmacists from those routinely referred by general practitioners for HMR. The primary outcome was the proportion of patients with any reduction in DBI at 3-months follow-up. Secondary outcomes included change in DBI continuous score at 3-months, HMR recommendations to change DBI and clinical outcomes.
There were 201 patient participants at baseline (n = 88 intervention, n = 113 comparison), with 159 followed-up at 3-months (n = 63 intervention, n = 96 comparison). The proportion of patients with a reduction in DBI was not significantly different at 3-months (intervention 17%, comparison 11%; adjusted odds ratio 1.44, 95% confidence interval 0.56-3.80). Regarding secondary outcomes, there was no difference in change in DBI score at 3-months. However, the HMR report made recommendations to reduce DBI for a significantly greater proportion of patients in the intervention than in the comparison group (intervention 37%, comparison 14%; adjusted odds ratio 3.20, 95% confidence interval 1.50-6.90). No changes were observed in clinical outcomes.
Implementation of G-MEDSS within HMR did not reduce patients' DBI at 3 months compared with usual care HMR.
目标导向的药物审查电子决策支持系统（G-MEDSS）评估并报告患者的目标、对药物减量的态度和药物负担指数（DBI）评分，该评分衡量抗胆碱能和镇静药物的累积暴露量。本研究评估了在家庭药物审查（HMR）中实施 G-MEDSS 对 DBI 暴露和临床结果的影响。
在澳大利亚进行了一项集群随机临床试验。经过认证的临床药师被随机分配到干预组（G-MEDSS 联合常规 HMR）或对照组（仅常规 HMR）。药剂师从常规转介给全科医生进行 HMR 的患者中招募患者。主要结局是在 3 个月随访时任何 DBI 降低的患者比例。次要结局包括 3 个月时 DBI 连续评分的变化、HMR 建议改变 DBI 和临床结果。
基线时有 201 名患者（n=88 例干预组，n=113 例对照组），其中 159 名在 3 个月时随访（n=63 例干预组，n=96 例对照组）。3 个月时 DBI 降低的患者比例在干预组和对照组之间没有显著差异（干预组 17%，对照组 11%；调整后的优势比 1.44，95%置信区间 0.56-3.80）。关于次要结局，3 个月时 DBI 评分的变化没有差异。然而，在干预组中，HMR 报告建议减少 DBI 的患者比例明显高于对照组（干预组 37%，对照组 14%；调整后的优势比 3.20，95%置信区间 1.50-6.90）。临床结果没有变化。
与常规 HMR 相比，在 HMR 中实施 G-MEDSS 并没有降低患者在 3 个月时的 DBI。
