Milos Nymberg Veronica, Lenander Cecilia, Borgström Bolmsjö Beata
Department of Clinical Sciences, Lund University, Malmö, Sweden.
CPF, Center for Primary Healthcare Research, Malmö, Sweden.
Drug Healthc Patient Saf. 2021 Jan 27;13:1-9. doi: 10.2147/DHPS.S283708. eCollection 2021.
Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions.
The aim of this study was to assess the impact of MRs' on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a cohort from a randomized controlled study.
Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months.
An observational follow-up was performed in a cohort of 369 patients, previously randomized to an intervention group (182) and a control group (187). Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 42% (HR = 0.58, 95% CI 0.37-0.92, p=0.021), but found no difference in mortality (HR = 1.12, 95% CI 0.78-1.61, p=0.551) between the groups.
We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on delayed hospital admissions. The study is registered at ClinicalTrials.gov, registration number NCT04040855, Unique Protocol ID 2018/8.
老年人群中与药物相关的问题很常见且呈上升趋势。多专业药物评估（MR）已成为一种优化体弱老年患者药物治疗的方法。研究尚未能够确凿证明药物评估对死亡率或住院率的影响。
本研究的目的是在一项随机对照研究队列中的369名初级保健体弱患者群体中，评估药物评估在6个月和12个月后对住院率和死亡率的影响。
患者被随机分为干预组（接受药物评估）和对照组（接受常规护理）。收集了6个月和12个月时关于死亡率和住院率的描述性数据。对12个月内的死亡时间和首次住院时间进行了生存分析。
对一个队列中的369名患者进行了观察性随访，这些患者先前被随机分为干预组（182名）和对照组（187名）。大多数患者（75%）为女性，居住在养老院。6个月时，对照组基线人群中有50名患者（27%）至少住院一次，干预组为40名患者（21%）。12个月时，对照组的这一比例增至70名（37%），干预组为53名（29%）。与常规护理相比，我们发现药物评估使12个月内的住院风险降低了42%（HR = 0.58，95% CI 0.37 - 0.92，p = 0.021），但两组之间的死亡率没有差异（HR = 1.12，95% CI 0.78 - 1.61，p = 0.551）。
我们建议在体弱老年患者的护理中推荐药物评估，因为其对延迟住院可能有益。该研究已在ClinicalTrials.gov注册，注册号为NCT04040855，唯一方案识别码为2018/8。
