Celikkayalar Ercan, Puustinen Juha, Palmgren Joni, Airaksinen Marja
Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
Hospital Pharmacy Department, Satasairaala Central Hospital, Pori, Finland.
Integr Pharm Res Pract. 2021 Apr 22;10:23-32. doi: 10.2147/IPRP.S280523. eCollection 2021.
Collaborative medication reviews (CMR) have been shown to reduce inappropriate prescribing (IP) in various settings. This study aimed at describing a CMR practice in an emergency department (ED) short-term ward in Finland to investigate IP in pre-admission medications.
Pre-admission medications were collaboratively reviewed for all the adult ED admissions within a 5-month study period in 2016. Types of IP were inductively categorized, and descriptive statistics were used to show the incidence and type of IP events.
The pre-admission medications of 855 adult ED patients were reviewed by the pharmacist, with 113 IP events identified in 83 (9.7%) of the patients. The majority (81%, n=67) of these patients were older adults (≥65 years). Of these 94 IP events identified in 67 older patients, 58 (62%) were confirmed by the ED physicians. The following 3 main categories were inductively developed for the types of identified and confirmed IP events: 1) Misprescribing (prescription of medications that significantly increase the risk of adverse drug events); 2) Overprescribing (prescription of medications for which no clear clinical indications exist); and 3) Underprescribing (omission of potentially beneficial medications that are clinically indicated for treatment or prevention of a disease). Misprescribing was the most common type of IP identified (79% of the identified and 72% confirmed IP events). Benzodiazepines (29%) and antidepressants (28%) were involved in 33 out of 58 (57%) confirmed IP events. Medications with strong anticholinergic effects were involved in 19% of the confirmed IP events.
The CMR practice was able to identify IP in pre-admission medications of about one-tenth of ED patients. Older patients using benzodiazepines and drugs with strong anticholinergic effects should be paid special attention to ED admissions.
协作药物审查（CMR）已被证明可在各种环境中减少不适当处方（IP）。本研究旨在描述芬兰一家急诊科（ED）短期病房的CMR实践，以调查入院前用药中的IP情况。
对2016年为期5个月的研究期间所有成年ED入院患者的入院前用药进行协作审查。对IP类型进行归纳分类，并使用描述性统计数据显示IP事件的发生率和类型。
药剂师审查了855名成年ED患者的入院前用药，在83名（9.7%）患者中发现了113起IP事件。这些患者中的大多数（81%，n = 67）为老年人（≥65岁）。在这67名老年患者中确定的94起IP事件中，58起（62%）得到了ED医生的确认。针对已确定和确认的IP事件类型归纳出以下3个主要类别：1）错误处方（开具显著增加药物不良事件风险的药物）；2）过度处方（开具无明确临床指征的药物）；3）处方不足（遗漏临床上有治疗或预防疾病指征的潜在有益药物）。错误处方是最常见的IP类型（已确定的IP事件中有79%，确认的IP事件中有72%）。苯二氮䓬类药物（29%）和抗抑郁药（28%）涉及58起确认的IP事件中的33起（57%）。具有强抗胆碱能作用的药物涉及19%的确认IP事件。
CMR实践能够在约十分之一的ED患者入院前用药中识别出IP。使用苯二氮䓬类药物和具有强抗胆碱能作用药物的老年患者在ED入院时应予以特别关注。
