Hughes David, Jordan Meirion, Logan Patricia A, Willson Alan, Snelgrove Sherrill, Storey Melanie, Vaismoradi Mojtaba, Jordan Sue
Faculty of Health and Life Sciences, Swansea University, Swansea SA2 8PP, UK.
Independent Researcher, Swansea SA9 2GA, UK.
Geriatrics (Basel). 2020 Oct 19;5(4):79. doi: 10.3390/geriatrics5040079.
Advances in medicines have increased the effectiveness of treatments and the social and cultural authority of doctors. However, as prescribing has become the dominant modality of treatment, the "pharmaceuticalization" of medical practice has often resulted in treatment "at a distance", with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. A team approach to checking patients systematically for ADRs, as detailed in manufacturers' literature, can minimise medication errors, but regular review is rare. This paper explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation, falls, or drug-induced Parkinsonism. We show how multidisciplinary initiatives to optimise prescribing can be supported by using a recognised resource-the adverse drug reaction profile (ADRe). The profile identifies and documents patients' signs and symptoms of putative ADRs. Better monitoring allows professionals to adjust prescribing and respond to identified problems with agility. Implementation of systematic monitoring will require changes to the regulatory regime and better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and help address ageism and the socio-economic health divide.
医学的进步提高了治疗效果以及医生的社会和文化权威。然而，由于开处方已成为主要的治疗方式，医疗实践的“药物化”往往导致“远距离”治疗，医生与患者的接触有限。在社会层面上与开处方的医生距离较远的老年人和贫困人群，比普通人群遭受更多的药物不良反应（ADR）。正如药品制造商文献中所详述的，采用团队方法系统地检查患者的药物不良反应，可以将用药错误降至最低，但定期复查却很少见。本文阐述了药物监测对于保护老年患者免受医源性伤害（如过度镇静、跌倒或药物性帕金森综合征）的益处。我们展示了如何通过使用一种公认的资源——药物不良反应概况（ADRe）来支持优化处方的多学科举措。该概况识别并记录患者疑似药物不良反应的体征和症状。更好的监测使专业人员能够调整处方并灵活应对已发现的问题。实施系统监测将需要改变监管制度并加强专业间的合作。为护理人员、护士和药剂师提供一个结构化的系统来监测患者，将使相关医学知识民主化，并有助于消除年龄歧视以及社会经济健康差距。
