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社区用药教育、数据和安全(C-MEDS):试点项目的结果。

Community Medication Education, Data, & Safety (C-MEDS): Findings from a Pilot Project.

机构信息

Independence at Home, SCAN Health Plan, Long Beach, California, USA.

University of Southern California, Leonard Davis School of Gerontology, Los Angeles, California, USA.

出版信息

J Am Geriatr Soc. 2021 Mar;69(3):813-821. doi: 10.1111/jgs.16981. Epub 2020 Dec 23.

Abstract

OBJECTIVES

Medication-related problems remain one of the largest health risks for older adults, yet there are few resources available to effectively reduce medication-related problems for community dwelling older adults. The aim of this pilot program was to determine the effectiveness of a multifaceted medication intervention on medication adherence and self-efficacy in medication use.

DESIGN

A single sample, pre-post-test design.

SETTING

This pilot study was conducted at Independence at Home, a Senior Care Action Network (SCAN) community service in Southern California.

PARTICIPANTS

One hundred and eighty community-dwelling, diverse older adults with potential medication-related problems and their caregivers.

INTERVENTION

The Community Medication Education, Data, & Safety (C-MEDS) Program identified community-dwelling older adults with potential medication-related problems and provided in-depth personalized medication safety, management and support, based on an in-home assessment and interventions delivered by trained geriatrics experts including pharmacists, nurses, a community health worker, and a pharmacy technician.

MEASUREMENTS

The primary outcomes included medication use self-efficacy, measured by the MUSE, and select medication adherence measures. Adherence was measured via pill count and via the MedAdhIR tool, a scale that measures risk for medication non-adherence.

RESULTS

Following participation in the C-MEDS program, community-dwelling older adult C-MEDS graduates (n = 105) had higher self-efficacy in managing medications (P < .001). Additionally, C-MEDS graduates also exhibited increased adherence to three types of medications (statins, diabetes-related, and certain hypertension drugs; P < .001). Moreover, risk of non-adherence declined significantly following C-MEDS graduation (P < .001).

CONCLUSION

C-MEDS holds promise as an effective intervention among community-dwelling older adults in improving medication self-efficacy, medication adherence among select medications, and reducing risk for non-adherence. Additional studies are needed to assess replicability and impact on clinical outcomes.

摘要

目的

药物相关问题仍然是老年人面临的最大健康风险之一,但目前几乎没有资源可用于有效减少社区居住的老年人的药物相关问题。本试验计划的目的是确定多方面药物干预对药物使用的药物依从性和自我效能的有效性。

设计

单样本,前后测试设计。

地点

本试点研究在南加州的独立在家,高级护理行动网络(SCAN)社区服务中进行。

参与者

180 名有潜在药物相关问题的社区居住的多样化老年人及其护理人员。

干预措施

社区药物教育,数据和安全(C-MEDS)计划确定了有潜在药物相关问题的社区居住的老年人,并根据家庭评估和由药剂师,护士,社区卫生工作者和药剂师技术员提供的培训老年医学专家进行的干预措施,提供深入的个性化药物安全,管理和支持。

测量

主要结果包括药物使用自我效能,通过 MUSE 测量,以及选择药物依从性测量。通过药丸计数和 MedAdhIR 工具测量依从性,该工具测量药物不依从的风险。

结果

参加 C-MEDS 计划后,社区居住的 C-MEDS 毕业生(n = 105)在管理药物方面的自我效能更高(P <.001)。此外,C-MEDS 毕业生还表现出对三种药物(他汀类药物,糖尿病相关药物和某些高血压药物)的依从性增加(P <.001)。此外,C-MEDS 毕业后,不依从的风险显著下降(P <.001)。

结论

C-MEDS 有望成为改善社区居住的老年人药物自我效能,特定药物的药物依从性以及降低不依从风险的有效干预措施。需要进一步研究评估其可复制性和对临床结果的影响。

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