Stuhec Matej, Lah Lea
Faculty of Pharmacy, University of Ljubljana, Askerceva Cesta 7, Ljubljana, SI-1000, Slovenia.
University of Ljubljana, Ljubljana, Slovenia.
Ther Adv Psychopharmacol. 2021 Apr 22;11:20451253211011007. doi: 10.1177/20451253211011007. eCollection 2021.
Mental disorders pose a significant clinical burden and affect approximately one-third of older adults. Although studies have shown positive impacts of clinical pharmacist (CP) interventions within the general population, the long-term effects of such cooperation on geropsychiatric patients in primary care settings are not yet known. This study evaluated whether CP interventions have a long-term impact on the quality of medication prescribing in geropsychiatric patients.
We conducted a retrospective non-interventional observational pre-post study for the 2015-2017 period, involving patients aged 65 or above for whom a medication review was provided by a CP. The study included participants with mental disorders treated with polypharmacy, including at least one psychotropic. Potentially inappropriate medications (PIMs) in elderly patients were determined with the Priscus list, and potential type X drug-drug interactions (pXDDIs) with Lexicomp®. Up-to-date treatment guidelines were used to evaluate patient pharmacotherapy, and patient medication was evaluated before the initial medication review and again 6 months later.
The study included 48 patients (79.4 years, SD = 8.13) receiving a total of 558 medications (155 for the treatment of mental disorders). The number of medications decreased by 9.5% after the medication review. The CP proposed 198 interventions related to psychotropics, of which 108 (55%) were accepted by the general practitioners. All accepted (99.1%) interventions except one were still maintained 6 months after the interventions had been proposed. They led to a significant decrease in the total number of medications, PIMs, and pXDDIs ( < 0.05), and improved treatment guidelines adherence.
CP interventions decreased the number of medications, PIMs, and pXDDIs, and almost all interventions were maintained 6 months later. These results provide evidence for the positive effects of CP interventions in a primary care setting. Additional research with a larger sample size and a randomized study design is needed.
精神障碍带来了重大的临床负担，影响着约三分之一的老年人。尽管研究表明临床药师（CP）干预对普通人群有积极影响，但这种合作对初级保健机构中老年精神科患者的长期影响尚不清楚。本研究评估了CP干预对老年精神科患者用药处方质量是否有长期影响。
我们对2015 - 2017年期间进行了一项回顾性非干预性观察性前后研究，纳入了65岁及以上接受CP药物审查的患者。该研究包括接受多种药物治疗（包括至少一种精神药物）的精神障碍患者。使用普里斯库斯清单确定老年患者潜在不适当用药（PIM），并使用Lexicomp®确定潜在的X型药物相互作用（pXDDI）。采用最新的治疗指南评估患者药物治疗情况，并在首次药物审查前及6个月后再次评估患者用药情况。
该研究纳入了48名患者（79.4岁，标准差 = 8.13），共接受558种药物治疗（其中155种用于治疗精神障碍）。药物审查后药物数量减少了9.5%。CP提出了198项与精神药物相关的干预措施，其中108项（55%）被全科医生接受。除一项外，所有被接受的干预措施（99.1%）在提出干预措施6个月后仍被维持。这些干预措施使药物总数、PIM和pXDDI显著减少（P < 0.05），并提高了对治疗指南的依从性。
CP干预减少了药物数量、PIM和pXDDI，且几乎所有干预措施在6个月后仍被维持。这些结果为CP干预在初级保健机构中的积极作用提供了证据。需要进行更大样本量和随机研究设计的进一步研究。
